Abstract
Substantial progress has been made in the treatment of leukemia in childhood. Despite this, leukemia remains a leading cause of pediatric cancer-related mortality and the prognosis is guarded for individuals with relapsed or refractory disease. Standard therapies are associated with a wide array of acute and long-term toxicities and further treatment intensification may not be tolerable or beneficial. The curative potential of allogeneic stem cell transplantation is due in part to the graft-versus-leukemia effect, which provides evidence for the therapeutic capacity of immune-based therapies. In recent years there have been significant advances in the development and application of immunotherapy in the treatment of leukemias, including the demonstration of activity in chemotherapy-resistant cases. This review summarizes immunotherapeutic approaches in the treatment of pediatric leukemia including current results and future directions.
Highlights
Leukemia is the most common form of cancer in childhood
This review summarizes immunotherapeutic approaches in the treatment of pediatric leukemia including current results and future directions
The graft-versus-leukemia (GVL) effect associated with allogeneic stem cell transplantation (SCT) is an immunologic reaction mediated by donor lymphocytes against foreign antigens expressed on leukemia cells
Summary
Leukemia is the most common form of cancer in childhood. Acute lymphoblastic leukemia (ALL) accounts for approximately 75% and acute myelogenous leukemia (AML) about 20% of pediatric leukemia. There has been significant progress in the development and application of immunotherapy in the treatment of leukemias of childhood Such immune-based therapies have the potential to overcome resistance to and decrease side effects of standard therapy. The graft-versus-leukemia (GVL) effect associated with allogeneic SCT is an immunologic reaction mediated by donor lymphocytes against foreign antigens expressed on leukemia cells. This GVL effect plays an important role in leukemia-free survival after transplantation (Marmont et al, 1991; Porter and Antin, 1999). Increasing the intensity of GVHD prophylaxis can reduce the GVL effect leading to a higher risk of relapse in children with acute leukemia. The results of DLI are poor for children with ALL and AML (Porter et al, 2010)
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