Optimal central nervous system prophylaxis in Philadelphia chromosome-positive acute lymphoblastic leukemia: collateral damage in the imatinib era?

Bassan, Renato

doi:10.3109/10428194.2011.575494

Cited by 5 publications

(3 citation statements)

References 7 publications

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“…16,23,24 CNS relapse confers a very bad outlook and is still observed in some patients with ALL. ITD could help optimize the design of modern radiation-free prophylactic regimens and improve the compliance to intrathecal therapy of patients at high risk of complications, such as the elderly and those with Ph + ALL, [25][26][27] limiting the total number of lumbar punctures to six or fewer. In the German elderly Ph -ALL trial, 25 the use of ITD instead of intrathecal methotrexate reduced induction mortality compared to that in a historical cohort of patients.…”

Section: Discussionmentioning

confidence: 99%

Randomized trial of radiation-free central nervous system prophylaxis comparing intrathecal triple therapy with liposomal cytarabine in acute lymphoblastic leukemia

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Randomized trial of radiation-free central nervous system prophylaxis comparing intrathecal triple therapy with liposomal cytarabine in acute lymphoblastic leukemia

et al. 2015

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“…IM is not a CNS-active drug [102], however, it may cause a defective platelet function facilitating the occurrence of subdural hematomas by repeated intrathecal therapy [103]. Ways of counteracting this effect were suggested [104], including the intrathecal administration of liposome-encapsulated cytarabine, which allows reduction of total lumbar punctures and is highly active in CNS relapse of Ph+ ALL [105]. In contrast to IM, DAS is a CNS-active drug [106] and it could, therefore, be used in patients at high risk of or with CNS involvement; however, comparative rates of CNS progression between IM and DAS studies are not yet known.…”

Section: Cns Involvementmentioning

confidence: 98%

Current and future management of Ph/BCR-ABL positive ALL

Maino

Sancetta

Viero

et al. 2014

Expert Review of Anticancer Therapy

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Following the introduction of targeted therapy with tyrosine kinase inhibitors (TKI) at the beginning of the past decade, the outcome of patients with Philadelphia-chromosome positive acute lymphoblastic leukemia (Ph+ ALL) has dramatically improved. Presently, the use of refined programs with first/second generation TKI's and chemotherapy together with allogeneic stem cell transplantation allow up to 50% of all patients to be cured. Further progress is expected with the new TKI ponatinib, overcoming resistance caused by T315I point mutation, other targeted therapies, autologous transplantation in molecularly negative patients, therapeutic monoclonal antibodies like inotuzumab ozogamicin and blinatumomab, and chimeric antigen receptor-modified T cells. Ph+ ALL could become curable in the near future even without allogeneic stem cell transplantation, minimizing the risk of therapy-related death and improving greatly the quality of patients' life.

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“…74 Therefore intrathecal injections should be performed with specific precautions. 75 It remains open whether less intensive CNS prophylaxis may be required if dasatinib, which crosses the blood-brain barrier, is used as first-line therapy.…”

Section: Treatment Of Older Patients With Ph/bcr-abl-positive (Ph1) Allmentioning

confidence: 99%

How I treat older patients with ALL

Gökbuget

2013

Blood

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The treatment of older patients with acute lymphoblastic leukemia (ALL) is an unmet medical need. In Western countries, the population is aging, which means there will be an increasing number of older patients. However, in the past few decades, there has been little improvement in treating them, and few clinical trials specifically designed for older patients with ALL have been reported. Older patients with ALL have a significantly lower complete response rate, higher early mortality, higher relapse rate, and poorer survival compared with younger patients. This is partly explained by a higher incidence of poor prognostic factors. Most importantly, intensive chemotherapy with or without stem cell transplantation, both of which are successful in younger patients, is less well tolerated in older patients. For the future, the most promising approaches are optimized supportive care, targeted therapies, moderately intensified consolidation, and reduced-intensity stem cell transplantation. One of the most important challenges for physicians is to differentiate between fit and unfit older patients in order to offer both groups optimal treatment regarding toxicity and mortality risks, quality of life, and long-term outcome. Prospective trials for older patients with ALL are urgently needed.

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Optimal central nervous system prophylaxis in Philadelphia chromosome-positive acute lymphoblastic leukemia: collateral damage in the imatinib era?

Cited by 5 publications

References 7 publications

Randomized trial of radiation-free central nervous system prophylaxis comparing intrathecal triple therapy with liposomal cytarabine in acute lymphoblastic leukemia

Randomized trial of radiation-free central nervous system prophylaxis comparing intrathecal triple therapy with liposomal cytarabine in acute lymphoblastic leukemia

Current and future management of Ph/BCR-ABL positive ALL

How I treat older patients with ALL

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