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Theoretical basis for maintenance therapy of childhood ALL

Leukemia volume 19, pages 1704–1705 (2005)Cite this article

TO THE EDITOR

Based on experimental data, Zuna et al1 offer a novel explanation of ‘late’ relapse in childhood ALL and argue persuasively that this explains the striking responsiveness of such off treatment relapses to retreatment. Their explanation of such relapses may also throw light on the requirement for maintenance (continuation) therapy in childhood ALL – a need which is empirically established but which lacks a theoretical basis. Pui for example states, ‘For reasons that are poorly understood, children with ALL (except those with mature B-cell leukemia) require long-term continuation treatment.2’ It is striking in this context that prolonged maintenance therapy appears to be required only for ‘classic’ pre-B childhood ALL, not for mature B- or T-cell ALL – this is precisely the subtype for which Greaves has developed an elegant and widely accepted model of pathogenesis.3 The essence of the Greaves' hypothesis is that childhood leukemia of this subtype is the consequence of a pre- or perinatal event creating a preleukemic clone; he further proposes that emergence of a leukemia clone is a consequence of an aberrant immune response and that this is most likely to occur when there is a delay in the normal pattern of exposure of an infant's immune system to infection. It is clear that childhood leukemia is not merely a consequence of relative immune deficiency since children do not develop the types of cancer commonly seen in immunosuppressed adults, and adults, in turn, do not develop typical childhood leukemia when immunosuppressed. McNally and Eden4 have published a review of the evidence relating to an infectious etiology of childhood leukemia.

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References

  1. Zuna J, Ford AM, Peham M, Patel N, Saha V, Eckert C et al. TEL deletion analysis supports a novel view of relapse in childhood acute lymphoblastic leukemia. Clin Cancer Res 2004; 10: 5355–5360.

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  2. Pui CH, Campana D, Evans WE . Childhood acute lymphoblastic leukaemia – current status and future perspectives. Lancet Oncol 2001; 2: 597–607.

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  3. Greaves MF . Biological models for leukaemia and lymphoma. IARC Sci Publ 2004; 157: 351–372.

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  4. McNally RJ, Eden OB . An infectious aetiology for childhood leukaemia: a review of the evidence. Br J Haematol 2004; 127: 243–263.

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  1. Research Office, Leukaemia Research Fund, UK

    K Campbell

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  1. K Campbell
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Correspondence to K Campbell.

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Submitted in a private capacity; opinions expressed in this submission do not necessarily represent those of the Leukaemia Research Fund.

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Campbell, K. Theoretical basis for maintenance therapy of childhood ALL. Leukemia 19, 1704–1705 (2005). https://doi.org/10.1038/sj.leu.2403849

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