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Motohiro Kato - Pediatric Acute Lymphoblastic Leukemia

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Motohiro Kato Pediatric Acute Lymphoblastic Leukemia
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Motohiro Kato - Pediatric Acute Lymphoblastic Leukemia
Pediatric Acute Lymphoblastic Leukemia
Motohiro Kato
Pediatric Acute Lymphoblastic Leukemia

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Editor Motohiro Kato Pediatric Acute Lymphoblastic Leukemia Editor - photo 1
Editor
Motohiro Kato
Pediatric Acute Lymphoblastic Leukemia
Editor Motohiro Kato Department of Transplantation and Cell Therapy Childrens - photo 2
Editor
Motohiro Kato
Department of Transplantation and Cell Therapy, Childrens Cancer, Center National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
ISBN 978-981-15-0547-8 e-ISBN 978-981-15-0548-5
https://doi.org/10.1007/978-981-15-0548-5
Springer Nature Singapore Pte Ltd. 2020
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.

The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore

Preface

On behalf of all the authors, I am pleased to present the first edition ofPediatric Acute Lymphoblastic Leukemia. Acute lymphoblastic leukemia is the most common malignancy during childhood. Previously, the survival probability had been 1020%; however, the cure rate has dramatically improved up to 8090%. Improved supportive care, treatment stratification based on relapse risk, biological features of leukemic cells, and optimization of treatment regimens by nationwide and international collaboration have contributed to this dramatic improvement.

This book consists of 17 chapters written by experts in this field, describing the updated information on biology, diagnostic procedure, treatment, and supportive therapy of pediatric acute lymphoblastic leukemia.

I could not have completed this book without the help of Ms. Saki Kasai and Ms. Kripa Guruprasad of Springer. I dedicate this book to our patients, parents, colleagues, and mentors. I hope thatPediatric Acute Lymphoblastic Leukemiais useful for not only pediatric hematologists but also medical students, interns, residents, and fellowship doctors.

Motohiro Kato
Setagaya-ku, Tokyo, Japan
Contents
Part IEpidemiology and Diagnosis of Pediatric ALL
Motohiro Kato
Toshihiko Imamura
Motohiro Kato
Takao Deguchi
Motohiro Kato
Part IITreatment of Pediatric ALL
Motohiro Kato
Atsushi Sato
Reiji Fukano
Daisuke Tomizawa
Yuichi Kodama and Hiroyuki Shimada
Yasuhiro Okamoto
Etsuko Yamazaki
Ayumu Arakawa
Shunsuke Nakagawa
Motohiro Kato
Part IIISupportive Issues in Pediatric ALL
Michihiro Yano
Motohiro Kato
Part I Epidemiology and Diagnosis of Pediatric ALL
Springer Nature Singapore Pte Ltd. 2020
M. Kato (ed.) Pediatric Acute Lymphoblastic Leukemia https://doi.org/10.1007/978-981-15-0548-5_1
1. Overview
Motohiro Kato
(1)
Department of Transplantation and Cell Therapy, Childrens Cancer Center, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
Motohiro Kato
Email:
Abstract

Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer. Survival probability of pediatric ALL had been dismal at 50 years ago, but the most recent clinical trials with multiagent chemotherapy have achieved overall survival probability of better than 80%, thanks to better supportive care, treatment stratification based on relapse risk, and the biological features of leukemic cells. Diagnosis of ALL was based principally on morphological identification of leukemic blasts in bone marrow, and immunophenotype assessment by flow cytometry is necessary, and most pediatric ALL cases are clinically classified as B-cell precursor, T-cell ALL, or mature B-cell types, comprising 80%, 15%, and 5% of cases, respectively.

Keywords
Diagnosis Bone marrow aspiration
1.1 Introduction

Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer, consisting approximately 25% of malignant diseases in children. A slight male predominance has been observed, with a peak incidence between 1 and 4 years of age [].

Survival probability of pediatric ALL had been dismal at 50 years ago, and ALL was considered to be an intractable disease. However, beginning from the pivotal paper by Farber et al. showing that temporal remissions of pediatric ALL were achieved by folic acid antagonist (4-aminopteroyl-glutamic acid), new era of chemotherapy aiming to conquer ALL started. The most recent clinical trials have achieved overall survival probability of better than 80% []. The main contributors to this dramatic success are better supportive care, treatment stratification based on relapse risk and the biological features of leukemic cells, and the accumulation of evidence obtained by clinical trials through nationwide and international collaboration.

1.2 Symptoms and Diagnosis
Symptoms of ALL are generally non-specific and various and include prolonged fever, bone pain, swollen lymph nodes, petechia, and dyspnea due to mediastinum enlargement. Some patients were suspected as having leukemia by image findings, such as X-ray and/or magnetic resonance imaging (MRI) (Fig. ).
Fig 11 Imaging findings of ALL cases a X-ray findings of the knee of - photo 3
Fig. 1.1

Imaging findings of ALL cases (a) X-ray findings of the knee of leukemia case. Metaphyseal lucent band was observed. (b) Abnormal signal (low signal in T1-weighted image) by magnetic resonance imaging (MRI)

Diagnosis of ALL was based principally on morphological identification of leukemic bone marrow blasts exceeding 25% (Fig. ). Immunophenotype assessment by flow cytometry (FCM) is necessary, and most pediatric ALL cases are clinically classified as B-cell precursor (BCP), T-cell ALL, or mature B-cell types, comprising 80%, 15%, and 5% of cases, respectively.
Fig 12 Typical morphology of ALL May-Giemsa staining of bone marrow - photo 4
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