Acute Leukemias IV: Prognostic Factors and Treatment by E. D. Thomas (auth.), Prof. Dr. T. Büchner, Prof. Dr. W.

By E. D. Thomas (auth.), Prof. Dr. T. Büchner, Prof. Dr. W. Hiddemann, Priv. Doz. Dr. B. Wörmann, Prof. Dr. G. Schellong, Prof. Dr. J. Ritter (eds.)

The charges of acute leukemia healing have steadily more desirable during the last decade. scientific research effects replicate the impression of chemotherapy depth and period, the function of lengthy upkeep, intensified consolidation or very early intensification. additional growth has additionally been accomplished in bone marrow trans­ plantation, and up to date potential experiences and meta-analyses have contributed comparisons of the excessive antileukemic efficacy of bone marrow transplantation to that of more suitable chemotherapy. this enables a extra profitable combining of the 2 varieties of therapy. New prognostic elements have emerged from either cytogenetic and molecular genetic examine. therefore, the Philadelphia chromosome translocation and the bcr/abl gene rearrangement have confirmed to be the dominating possibility consider acute lymphoblastic leukemia. because the frequency raises with age, changes in diagnosis among little ones and adults could be defined. overview of molecular and immunologic leukemia mobile markers has supplied a greater figuring out of residual leukemia in scientific remission, as a prognostic issue and in tracking the effectiveness of the antileukemic approach. fresh paintings on leukemic phone biology has led to novel healing methods corresponding to terminal differentiation via all-trans-retinoic acid, modulation of chemotherapy by means of hematopoietic progress elements resembling GM-CSF and enhancement of immunologic keep watch over by means of cytokines corresponding to interleukin 2. New antimicrobial medications and the appliance of often empiric anti-infectious concepts have helped decreasing the healing probability. hence, a few contemporary achievements have supplied us with new concepts within the administration of sufferers with acute leukemias.

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Other research activities designed to improve the results of marrow grafting, too numerous to describe in detail here, include the partial removal of T-cells to prevent GVHD, the use of monoclonal antibodies, either alone or conjugated to a toxin or radioactive isotope, for prevention of GVHD and for killing of malignant cells, the use of biologic response modifiers such as interferon or IL-2 and lymphokine activated 4 killer (LAK) cells, the removal of malignant cells from the marrow for autologous transplantation, the purification of hematopoietic stem cells for transplantation or gene transfer, and methods for down regulation of tumor necrosis factor alpha for reduction of the toxicity of the treatment regimens.

Department of Pediatrics, University of Freiburg, MathildenstraBe 1, 79106 Freiburg, Germany SAYCHENKO, V. G. Scientific Center for Hematology, Ministry of Health, Novozikovski pr, 4, Moscow 12167, Russia SAYER, H. G. Department of Bone Marrow Transplantation, University Hospital Essen, HufelandstraBe 55, 45147 Essen I, Germany U. W. Department of Bone Marrow Transplantation, University Hospital of Essen, HufelandstraBe 55, 45147 Essen, Germany SCHAEFER, G. Medical Center Saint-Louis, I, Avenue Claude Vellefaux, 75475 Paris, Cedex 10, France SCHAISON, SCHARDT, CH.

More recently several studies have indicated that is also possible to detect MRD by use of PCR-mediated amplification of junctional regions of rearranged immunoglobulin (lg) and T-cell receptor (TcR) genes in clonal malignancies such as Band T-cell leukemias [8-13]. In the following we will summarize our experience with the application of PCR techniques in monitoring leukemia patients during the course of the disease. Molecular Monitoring of MRD in Acute Lymphoblastic Leukemia The vast majority oflymphoid malignancies are associated with clonal rearrangements of antigen receptor genes, the structures and patterns of which have been extensively reviewed [14].

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