Acute leukemia in children.

Abstract

Childhood leukemia comprises approximately one third of cancer cases in children younger than 15 years of age. The incidence of childhood acute lymphoblastic leukemia is increasing. Outcomes have improved for childhood acute lymphoblastic leukemia over past decades and we may be at the dawn of improvement for childhood acute nonlymphoblastic leukemia. Technology has advanced to where submicroscopic bone marrow involvement may be detected in some patients with acute lymphoblastic leukemia in remission or with isolated extramedullary relapse by conventional criteria. Outcome may be predicted by in vitro chemosensitivity assays like the methyl thiazol tetrachium assay. Estimation of end-induction residual leukemic burden by polymerase chain reaction-based clonotypic assays has prognostic significance and provides a strategy for quantitative assessment of new therapeutic interventions. The relation of outcome to the intracellular accumulation of 6-thioguanine nucleotides provides an additional therapeutic avenue. Improved cure rates require increased attention to the health status of long-term survivors.