Therapeutic challenges and possible solutions
| Reducing relapse | • Caution at reducing chemotherapy dosages in the absence of toxicity • Incorporating clinical trials with novel agents targeting unique biological features (e.g. JAK and mTOR inhibitors for CRLF2 expressing DS-ALL) |
| Reducing therapy related mortality | • Consider chemotherapy dose reduction in patients with ETV6-RUNX1 or High hyperdiploidy DS-ALL or MRD negativity at the end of induction, and excessive toxicity • Careful surveillance throughout therapy including maintenance period • Intense monitoring/supervision during periods of prolonged neutropenia • Aggressive treatment of suspected infections even in absence of neutropenia or fever • Influenza immunization of family members and reduced exposure to respiratory infections • Intravenous immunoglobulin therapy for children with low/normal or hypogammaglobulinemia • Antimicrobial prophylaxis for children with recurrent respiratory infections |
| Reducing relapse | • Caution at reducing chemotherapy dosages in the absence of toxicity • Incorporating clinical trials with novel agents targeting unique biological features (e.g. JAK and mTOR inhibitors for CRLF2 expressing DS-ALL) |
| Reducing therapy related mortality | • Consider chemotherapy dose reduction in patients with ETV6-RUNX1 or High hyperdiploidy DS-ALL or MRD negativity at the end of induction, and excessive toxicity • Careful surveillance throughout therapy including maintenance period • Intense monitoring/supervision during periods of prolonged neutropenia • Aggressive treatment of suspected infections even in absence of neutropenia or fever • Influenza immunization of family members and reduced exposure to respiratory infections • Intravenous immunoglobulin therapy for children with low/normal or hypogammaglobulinemia • Antimicrobial prophylaxis for children with recurrent respiratory infections |