Materiały źródłowe

• #1 Acute Lymphocytic Leukemia (ALL) Causes, Risk Factors, and Prevention | American Cancer Society

  https://www.cancer.org/cancer/types/acute-lymphocytic-leukemia/causes-risks-prevention.html

  There is no known way to prevent most cases of leukemia at this time. Most people who get acute lymphocytic leukemia have no known risk factors, so there is no way to prevent these leukemias from developing.

• #2 Screening/Prevention – Virginia Cancer Institute

  https://www.vacancer.com/cancer/leukemia/childhood-acute-lymphoblastic-leukemia/screening-prevention/

  Acute lymphoblastic leukemia cannot be prevented since we do not know the cause. Nevertheless, it would appear that pregnant women would be prudent to take adequate quantities of folic acid and iron supplementation as needed to avoid anemia. Pregnant women should also prudently avoid any drugs that are not absolutely necessary, especially alcohol, tobacco, marijuana, mind-altering drugs, and stimulants such as amphetamines. Diagnostic X-ray studies during pregnancy should be limited to what is absolutely necessary. […] The data on early infections and risk of ALL would suggest that early exposure to environmental pathogens could be of benefit in reducing several diseases.

• #3 Can Acute Lymphocytic Leukemia Be Prevented? | American Cancer Society

  https://www.cancer.org/cancer/types/acute-lymphocytic-leukemia/causes-risks-prevention/prevention.html

  Its not clear what causes most cases of acute lymphocytic leukemia (ALL). Since most people with ALL dont have risk factors that can be changed, for now, there is no known way to prevent most cases of ALL. […] Avoiding known cancer-causing chemicals, such as benzene, might lower the risk of getting ALL. But most experts agree that exposure to workplace and environmental chemicals seems to account for only a small portion of leukemias.

• #4 Acute Lymphoblastic Leukemia (ALL): Symptoms, Treatment & Prognosis

  https://my.clevelandclinic.org/health/diseases/21564-acute-lymphocytic-leukemia

  No, it cant. Children with ALL develop the condition because of genetic changes that happened before they were born. But adults with ALL may be able to lower their risk by avoiding carcinogens, including tobacco and toxic chemicals.

• #5 Explore Acute Lymphoblastic Leukaemia Prevention Risk factors and Prevention Measures at HCG Oncology

  https://www.hcgoncology.com/types-of-cancers/acute-lymphoblastic-leukaemia-prevention/

  There is no known way to achieve complete acute lymphoblastic leukemia prevention, as we are not fully aware of the causes of this condition. […] However, we do know that ALL is more common among children between the ages of 2 and 5, progresses rapidly, and will require immediate medical attention. […] That said, we have identified a few factors that can increase the risk of ALL and a few preventive measures that may help reduce the risk of this condition. […] Being aware of the different acute lymphoblastic leukemia risk factors can help in reducing ones chances of developing ALL. […] Here are certain relevant acute lymphoblastic leukemia prevention measures that one can adopt to reduce the risk of developing cancer. […] As tobacco consumption is considered a major risk factor for ALL, doctors advise avoiding tobacco smoking as a measure for possible leukemia prevention.

• #6 Acute Lymphocytic Leukemia (ALL): Symptoms, Risks, and Survival Rates

  https://www.healthline.com/health/acute-lymphocytic-leukemia-all

  Theres no confirmed cause of ALL. However, you can avoid several risk factors for it, such as: […] radiation exposure […] chemical exposure […] exposure to viral infections […] cigarette smoking […] prolonged exposure to diesel fuel, gasoline, pesticides, and electromagnetic fields.

• #7 Explore Acute Lymphoblastic Leukaemia Prevention Risk factors and Prevention Measures at HCG Oncology

  https://www.hcgoncology.com/types-of-cancers/acute-lymphoblastic-leukaemia-prevention/

  Maintaining a healthy body weight and making efforts to lose weight if required may also play an important role in possible leukemia prevention. […] Staying physically active with regular exercises is also found to help lower the risk of developing ALL. […] Minimizing exposure to environmental pollutants can contribute to possible acute lymphoblastic leukemia prevention. […] Having a nutritious and balanced diet can surely contribute to possible acute lymphoblastic leukemia prevention. […] It is advised to drink only filtered water as an acute lymphoblastic leukemia prevention measure. […] Staying up-to-date with vaccinations helps strengthen a person’s immune system and lower the risk of acute lymphoblastic leukemia. […] It is highly recommended to practice appropriate sun safety measures for high-risk ALL prevention. […] Understanding the prevention and risk factors for ALL can greatly help in increasing the high-risk acute lymphoblastic leukemia survival rate among patients.

• #8 Leukemia Awareness and Prevention | Leukemia | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/leukemia/leukemia-awareness-and-prevention/

  There is no known way to prevent leukemia, but avoiding tobacco and exposure to pesticides and industrial chemicals might help.

• #9 Leukemia Prevention: Tips, Facts, and More

  https://www.healthline.com/health/leukemia/leukemia-prevention

  The cause of leukemia isnt clear in most cases. […] Unfortunately, without a cause or causes that can be pinpointed, there are no clear ways to prevent leukemia. This is true for both children and adults. […] But there are steps you can take to reduce your risk. Reducing your risk doesnt mean thats impossible for you to get leukemia, but it does make it less likely. […] Until more research is done that finds specific ways to prevent leukemia, the best method is to reduce the risk factors you can control. […] There are a few lifestyle changes you can make to reduce your risk of leukemia. These steps can also reduce your risk of other types of cancer. They include: […] Smoking increases your risk of multiple types of cancer, including leukemia. Never smoking or quitting smoking will lower your risk of leukemia.

• #10 Leukemia Prevention: Tips, Facts, and More

  https://www.healthline.com/health/leukemia/leukemia-prevention

  Having obesity is another risk for leukemia that you can control. Taking steps to keep a moderate weight can reduce your risk of leukemia. […] The chemicals benzene and formaldehyde are known to increase your risk of leukemia. […] These prevention tips can be used to reduce your risk of both types of acute leukemia, acute lymphocytic leukemia (ALL) and acute myeloid leukemia (AML). […] But you can make changes to your lifestyle to reduce your risk of leukemia. Quitting smoking and managing your weight are the best steps you can take to lower your risk. These arent guaranteed to prevent leukemia, but lowering your risk is a positive step.

• #11 Screening/Prevention – Virginia Cancer Institute

  https://www.vacancer.com/cancer/leukemia/childhood-acute-lymphoblastic-leukemia/screening-prevention/

  Acute lymphoblastic leukemia cannot be prevented since we do not know the cause. Nevertheless, it would appear that pregnant women would be prudent to take adequate quantities of folic acid and iron supplementation as needed to avoid anemia. Pregnant women should also prudently avoid any drugs that are not absolutely necessary, especially alcohol, tobacco, marijuana, mind-altering drugs, and stimulants such as amphetamines. Diagnostic X-ray studies during pregnancy should be limited to what is absolutely necessary. […] The data on early infections and risk of ALL would suggest that early exposure to environmental pathogens could be of benefit in reducing several diseases.

• #12 Landmark paper sets out ‘unified theory’ for cause of acute lymphoblastic leukemia – Oncology Central

  https://www.oncology-central.com/landmark-paper-sets-out-unified-theory-for-cause-of-acute-lymphoblastic-leukemia/

  A landmark paper has outlined, for the first time, a possible cause of most cases of childhood leukemia, following more than a century of controversy about its origins. […] They discovered that ALL arises through a two-step process of genetic mutation and exposure to infection, which means that it may be preventable with treatments to stimulate or prime the immune system in infancy. […] The population studies also highlighted that early exposure to infection in infancy such as day care attendance and breast feeding can protect against ALL, most probably by priming the immune system. This suggests that childhood ALL may be preventable. […] The most important implication is that most cases of childhood leukemia are likely to be preventable. It might be done in the same way that is currently under consideration for autoimmune disease or allergies perhaps with simple and safe interventions to expose infants to a variety of common and harmless bugs, Greaves concluded.

• #13 Prevention of childhood leukaemia by lifestyle changes | Leukemia

  https://www.nature.com/articles/s41375-021-01220-6

  In order to progress further, more evidence of deficient microbiomes in ALL, from extensive monitoring of infants, is required. […] If we consider from these observations that most cases of childhood ALL may be preventable, it should be advertised as such by wide-scale promotion of beneficial yet modifiable lifestyle changes, including early social mixing and extended breast-feeding. […] Overall, this Perspective presents credible preliminary evidence that gut microbiome boosting by simple life style changes or dietary supplements might present viable strategies for risk reduction or prevention of childhood ALL and potentially other serious diseases; the Greaves group have the ability to convincingly persuade us.

• #14 Acute Lymphoblastic Leukaemia (Symptoms and Treatment)

  https://patient.info/doctor/acute-lymphoblastic-leukaemia-pro

  There are no widely accepted preventative strategies for ALL. Some studies have suggested that breastfeeding confers protection for childhood ALL but this remains controversial.

• #15 Prevention of childhood leukaemia by lifestyle changes | Leukemia

  https://www.nature.com/articles/s41375-021-01220-6

  In order to progress further, more evidence of deficient microbiomes in ALL, from extensive monitoring of infants, is required. […] If we consider from these observations that most cases of childhood ALL may be preventable, it should be advertised as such by wide-scale promotion of beneficial yet modifiable lifestyle changes, including early social mixing and extended breast-feeding. […] Overall, this Perspective presents credible preliminary evidence that gut microbiome boosting by simple life style changes or dietary supplements might present viable strategies for risk reduction or prevention of childhood ALL and potentially other serious diseases; the Greaves group have the ability to convincingly persuade us.

• #16 Landmark paper sets out ‘unified theory’ for cause of acute lymphoblastic leukemia – Oncology Central

  https://www.oncology-central.com/landmark-paper-sets-out-unified-theory-for-cause-of-acute-lymphoblastic-leukemia/

  A landmark paper has outlined, for the first time, a possible cause of most cases of childhood leukemia, following more than a century of controversy about its origins. […] They discovered that ALL arises through a two-step process of genetic mutation and exposure to infection, which means that it may be preventable with treatments to stimulate or prime the immune system in infancy. […] The population studies also highlighted that early exposure to infection in infancy such as day care attendance and breast feeding can protect against ALL, most probably by priming the immune system. This suggests that childhood ALL may be preventable. […] The most important implication is that most cases of childhood leukemia are likely to be preventable. It might be done in the same way that is currently under consideration for autoimmune disease or allergies perhaps with simple and safe interventions to expose infants to a variety of common and harmless bugs, Greaves concluded.

• #17 Immunoglobulin prophylaxis prevents hospital admissions for fever in pediatric acute lymphoblastic leukemia: results of a multicenter randomized trial – PubMed

  https://pubmed.ncbi.nlm.nih.gov/39113674/

  Infections lead to substantial morbidity during the treatment of acute lymphoblastic leukemia (ALL) in which the adaptive immune system is severely affected, leading to declining serum immunoglobulin levels. […] We performed a trial to investigate whether intravenous immunoglobulin (IVIG) prophylaxis in pediatric patients with ALL could prevent admissions for fever. […] In conclusion, in pediatric patients with medium-risk ALL, IVIG prophylaxis was associated with significantly fewer admissions for fever with negative blood cultures during maintenance treatment, resulting in fewer courses of antibiotic treatment and fewer chemotherapy adaptations.

• #18

  https://haematologica.org/article/view/haematol.2024.285428

  Infections lead to substantial morbidity during the treatment of acute lymphoblastic leukemia (ALL) in which the adaptive immune system is severely affected, leading to declining serum immunoglobulin levels. […] Theoretically, the increased risk of infections could be partially overcome by raising the low IgG levels with supplementary intravenous immunoglobulins (IVIG). […] In patients with primary immunodeficiency leading to agammaglobulinemia, prophylactic administration of IVIG has been shown to be effective in preventing infections. […] Currently, it is unknown whether prophylactic administration of IVIG could prevent infections during ALL treatment. […] The trial reported here investigated the role of IVIG prophylaxis in children with newly diagnosed ALL, treated according to the DCOG ALL-11 protocol.

• #19

  https://haematologica.org/article/view/haematol.2024.285428

  Infections lead to substantial morbidity during the treatment of acute lymphoblastic leukemia (ALL) in which the adaptive immune system is severely affected, leading to declining serum immunoglobulin levels. […] Theoretically, the increased risk of infections could be partially overcome by raising the low IgG levels with supplementary intravenous immunoglobulins (IVIG). […] In patients with primary immunodeficiency leading to agammaglobulinemia, prophylactic administration of IVIG has been shown to be effective in preventing infections. […] Currently, it is unknown whether prophylactic administration of IVIG could prevent infections during ALL treatment. […] The trial reported here investigated the role of IVIG prophylaxis in children with newly diagnosed ALL, treated according to the DCOG ALL-11 protocol.

• #20

  https://haematologica.org/article/view/haematol.2024.285428

  In conclusion, in pediatric patients with medium-risk ALL, IVIG prophylaxis was associated with significantly fewer admissions for fever with negative blood cultures during maintenance treatment, resulting in fewer courses of antibiotic treatment and fewer chemotherapy adaptations. […] Although IVIG prophylaxis did not result in the targeted 50% reduction of admissions for fever overall, it did result in significantly fewer admissions for fever with a negative blood culture, less empirical antibiotic therapy, and fewer adaptations of chemotherapy during maintenance treatment. […] IVIG prophylaxis likely prevented viral infections in our cohort of patients. […] IVIG prophylaxis was well tolerated and not associated with severe side effects, in line with previous observations, although there was a trend for more severe adverse events in the IVIG prophylaxis group. […] To conclude, in pediatric patients with medium-risk ALL, IVIG prophylaxis leads to a significant reduction of admissions for fever with negative blood cultures during maintenance treatment, and leads to a decrease in the use of empirical antibiotic therapy and chemotherapy adaptations.

• #21

  https://haematologica.org/article/view/haematol.2024.285428

  In conclusion, in pediatric patients with medium-risk ALL, IVIG prophylaxis was associated with significantly fewer admissions for fever with negative blood cultures during maintenance treatment, resulting in fewer courses of antibiotic treatment and fewer chemotherapy adaptations. […] Although IVIG prophylaxis did not result in the targeted 50% reduction of admissions for fever overall, it did result in significantly fewer admissions for fever with a negative blood culture, less empirical antibiotic therapy, and fewer adaptations of chemotherapy during maintenance treatment. […] IVIG prophylaxis likely prevented viral infections in our cohort of patients. […] IVIG prophylaxis was well tolerated and not associated with severe side effects, in line with previous observations, although there was a trend for more severe adverse events in the IVIG prophylaxis group. […] To conclude, in pediatric patients with medium-risk ALL, IVIG prophylaxis leads to a significant reduction of admissions for fever with negative blood cultures during maintenance treatment, and leads to a decrease in the use of empirical antibiotic therapy and chemotherapy adaptations.

• #22 Acute Lymphoblastic Leukemia and Invasive Mold Infections: A Challenging Field

  https://www.mdpi.com/2309-608X/8/11/1127

  Acute lymphoblastic leukemia (ALL) patients comprise a highly immunocompromised group due to factors associated either with the treatment or the disease itself. […] Although predisposing factors for IMIs in the setting of ALL are ill-defined, retrospective studies have indicated that a longer duration of neutropenia, treatment with high-dose corticosteroids, and a lack of antimold prophylaxis are associated with an increased risk of IMIs. […] Administering primary antimold prophylaxis in these patients has been challenging since incorporating azole antifungal agents is troublesome, considering the drug-to-drug interactions (DDIs) and increased toxicity that may occur when these agents are coadministered with vincristine, a fundamental component of ALL chemotherapy regimens. […] However, their use in ALL patients needs to be investigated through more clinical trials.

• #23 Incidence of invasive fungal infection in acute lymphoblastic and acute myelogenous leukemia in the era of antimold prophylaxis | Scientific Reports

  https://www.nature.com/articles/s41598-021-01716-2

  We showed that the incidence of IFI in ALL without antimold prophylaxis was not lower than that in AML with antimold prophylaxis, indicating that the notion of a lower risk of IFI in ALL than in AML needs to be modified. […] In addition, antimold prophylaxis could be considered in patients with ALL who are expected to have a longer duration of neutropenia than usual occasion. […] In conclusion, the incidence of IFI in ALL episodes without antimold prophylaxis was not lower than that in AML episodes with antimold prophylaxis, and a lack of antimold prophylaxis and a longer duration of neutropenia were independent risk factors for IFI. […] Therefore, in the current era of antimold prophylaxis, clinicians should also be on guard for the occurrence of IFI in patients with ALL, especially those with characteristics that put them at higher risk.

• #24 Incidence of invasive fungal infection in acute lymphoblastic and acute myelogenous leukemia in the era of antimold prophylaxis | Scientific Reports

  https://www.nature.com/articles/s41598-021-01716-2

  The incidence of invasive fungal infection (IFI) in patients with acute myeloid leukemia (AML) has decreased with the introduction of antimold prophylaxis. […] Although acute lymphoblastic leukemia (ALL) has a lower risk of IFI than does AML, the incidences of IFI in both AML and ALL in the era of antimold prophylaxis should be re-evaluated. […] A lack of antimold prophylaxis and prolonged neutropenia were independent risk factors for IFI. […] Clinicians should be on guard for detecting IFI in patients with ALL, especially those with risk factors. […] There are no specific recommendations for antifungal prophylaxis in cytotoxic chemotherapy for ALL, partly due to the lower incidence of IFI. […] Therefore, studies of the incidences of, and risk factors for IFI in AML or ALL that reflect the current situation are warranted to guide clinicians.

• #25 Acute Lymphoblastic Leukemia and Invasive Mold Infections: A Challenging Field

  https://www.mdpi.com/2309-608X/8/11/1127

  Acute lymphoblastic leukemia (ALL) patients comprise a highly immunocompromised group due to factors associated either with the treatment or the disease itself. […] Although predisposing factors for IMIs in the setting of ALL are ill-defined, retrospective studies have indicated that a longer duration of neutropenia, treatment with high-dose corticosteroids, and a lack of antimold prophylaxis are associated with an increased risk of IMIs. […] Administering primary antimold prophylaxis in these patients has been challenging since incorporating azole antifungal agents is troublesome, considering the drug-to-drug interactions (DDIs) and increased toxicity that may occur when these agents are coadministered with vincristine, a fundamental component of ALL chemotherapy regimens. […] However, their use in ALL patients needs to be investigated through more clinical trials.

• #26 Acute Lymphoblastic Leukemia and Invasive Mold Infections: A Challenging Field

  https://www.mdpi.com/2309-608X/8/11/1127

  Moreover, one retrospective study demonstrated that the incidence of IFIs in AML patients with antimold prophylaxis was not higher than that in ALL without antimold prophylaxis, reflecting the need to re-evaluate the risk in ALL patients and to find a suitable antifungal agent. […] On the whole, these studies, given their retrospective nature and the small and highly heterogeneous population samples, reflect the need to design further prospective trials in order to assess an accurate rate of IMIs in ALL and the impact of antimold prophylaxis as well as to recognize risk factors that are associated with a great risk of developing a fungal infection. […] Although the choice of antifungal agent for antimold prophylaxis in ALL is rather complex, given the risk of the aforementioned DDIs, especially when using azoles, several new agents with extended-spectrum activity and fewer DDIs are quite promising, and their use as primary antimold prophylaxis in this subset of patients should be investigated in more prospective clinical trials.

• #27 Adult Acute Lymphocytic Leukemia (ALL): Types and Treatment | OncoLink

  https://www.oncolink.org/cancers/blood-cancers/leukemia-acute-lymphocytic-leukemia-all/adult-acute-lymphocytic-leukemia-all-types-and-treatment

  Central Nervous System (CNS) Prophylaxis […] Less than 10 out of 100 patients have CNS involvement of leukemia (leukemia found in the spinal fluid) at the time of diagnosis. But, 50 to 75 out of 100 patients will have this by 1 year if they dont have preventive therapy. The most effective therapy to prevent CNS disease in adults with ALL is intrathecal chemotherapy. This means that chemotherapy is given directly into the spinal canal. This can be done by a lumbar puncture (spinal tap), or through a catheter called an Ommaya reservoir that is surgically placed in the head. This catheter allows you to have many intrathecal infusions without needing many lumbar punctures. The number of intrathecal infusions given depends on the subtype of ALL and the risk of CNS disease that subtype has.

• #28 CNS-Leukaemia Prophylaxis in Adult Acute Lymphoblastic Leukaemia | SpringerLink

  https://link.springer.com/chapter/10.1007/978-94-009-8919-1_15

  The prognosis for children with acute lymphoblastic leukaemia (ALL) has improved considerably since the introduction of CNS leukaemia prophylaxis by cranial irradiation and intrathecal administration of methotrexate (Mauer and Simone, 1976; Pinkel, 1979). The incidence of CNS-relapses dropped from 50% to approximately 5% of the children. […] Little is known about the efficacy of this treatment in adults, in whom CNS relapses are also frequent (Willemze et al., 1975; 1979; Gee et al., 1976; Lister et al., 1978.,Pavlovsky et al 1973).

• #29 Adult Acute Lymphocytic Leukemia (ALL): Types and Treatment | OncoLink

  https://www.oncolink.org/cancers/blood-cancers/leukemia-acute-lymphocytic-leukemia-all/adult-acute-lymphocytic-leukemia-all-types-and-treatment

  Central Nervous System (CNS) Prophylaxis […] Less than 10 out of 100 patients have CNS involvement of leukemia (leukemia found in the spinal fluid) at the time of diagnosis. But, 50 to 75 out of 100 patients will have this by 1 year if they dont have preventive therapy. The most effective therapy to prevent CNS disease in adults with ALL is intrathecal chemotherapy. This means that chemotherapy is given directly into the spinal canal. This can be done by a lumbar puncture (spinal tap), or through a catheter called an Ommaya reservoir that is surgically placed in the head. This catheter allows you to have many intrathecal infusions without needing many lumbar punctures. The number of intrathecal infusions given depends on the subtype of ALL and the risk of CNS disease that subtype has.

• #30 Adult Acute Lymphocytic Leukemia (ALL): Types and Treatment | OncoLink

  https://www.oncolink.org/cancers/blood-cancers/leukemia-acute-lymphocytic-leukemia-all/adult-acute-lymphocytic-leukemia-all-types-and-treatment

  Central Nervous System (CNS) Prophylaxis […] Less than 10 out of 100 patients have CNS involvement of leukemia (leukemia found in the spinal fluid) at the time of diagnosis. But, 50 to 75 out of 100 patients will have this by 1 year if they dont have preventive therapy. The most effective therapy to prevent CNS disease in adults with ALL is intrathecal chemotherapy. This means that chemotherapy is given directly into the spinal canal. This can be done by a lumbar puncture (spinal tap), or through a catheter called an Ommaya reservoir that is surgically placed in the head. This catheter allows you to have many intrathecal infusions without needing many lumbar punctures. The number of intrathecal infusions given depends on the subtype of ALL and the risk of CNS disease that subtype has.

• #31 Acute Lymphoblastic Leukemia (ALL) – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/leukemias/acute-lymphoblastic-leukemia-all

  Prophylactic CNS chemotherapy and sometimes CNS radiation […] CNS prophylaxis starts during induction and continues throughout all phases of treatment. Because lymphoblasts often infiltrate the cerebrospinal fluid and meninges, all regimens include CNS prophylaxis and treatment with intrathecal methotrexate, cytarabine, and hydrocortisone in combination or as monotherapy. High doses of systemic methotrexate and/or cytarabine penetrate the CNS, providing extra CNS prophylaxis if regimens include these drugs. Cranial nerve or whole-brain irradiation was previously often done for patients at high risk of CNS disease (eg, high WBC count, high serum lactate dehydrogenase, B-cell phenotype), but its use has been decreasing in recent years.

• #32 https://www.lls.org/leukemia/acute-lymphoblastic-leukemia/treatment/chemotherapy

  https://www.lls.org/leukemia/acute-lymphoblastic-leukemia/treatment/chemotherapy

  Because of acute lymphoblastic leukemia’s (ALL’s) rapid growth, most patients need to start chemotherapy soon after diagnosis. […] Even if ALL cells are not found in the spinal fluid, CNS prophylaxis is administered to prevent leukemia cells from spreading to the area around the brain and the spinal cord and is typically given to all patients throughout the entire course of ALL treatment during the induction phase, the consolidation phase and the maintenance phase.

• #33 Acute Lymphoblastic Leukemia (ALL) – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/leukemias/acute-lymphoblastic-leukemia-all

  Prophylactic CNS chemotherapy and sometimes CNS radiation […] CNS prophylaxis starts during induction and continues throughout all phases of treatment. Because lymphoblasts often infiltrate the cerebrospinal fluid and meninges, all regimens include CNS prophylaxis and treatment with intrathecal methotrexate, cytarabine, and hydrocortisone in combination or as monotherapy. High doses of systemic methotrexate and/or cytarabine penetrate the CNS, providing extra CNS prophylaxis if regimens include these drugs. Cranial nerve or whole-brain irradiation was previously often done for patients at high risk of CNS disease (eg, high WBC count, high serum lactate dehydrogenase, B-cell phenotype), but its use has been decreasing in recent years.

• #34 Induction treatments for acute lymphoblastic leukemia | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/acute-lymphoblastic-leukemia-all/treatment/induction

  With ALL, leukemia cells can spread to the brain and spinal cord (called the central nervous system, or CNS). Treatment given to prevent leukemia cells from spreading to the CNS is called CNS prophylaxis. During the induction phase of treatment, you typically receive CNS prophylaxis or treatment to destroy leukemia cells that have already spread to the CNS. […] CNS prophylaxis or treatment may include one or more of the following: […] intrathecal chemotherapy with methotrexate, cytarabine or a steroid such as prednisone […] high-dose methotrexate given intravenously (through an IV) […] radiation therapy to the brain and spinal cord.

• #35 Acute Lymphoblastic Leukemia (ALL) Treatment Protocols: Treatment Protocols

  https://emedicine.medscape.com/article/2004705-overview

  Patients with ALL have an increased chance of CNS involvement; therefore, intrathecal (IT) methotrexate is given as CNS prophylaxis. […] CNS prophylaxis consists of methotrexate 12 mg IT on day 2 and cytarabine 100 mg IT on day 8 of each cycle, or similar regimens. […] Patients with a high risk for CNS disease (mature B-cell, high proliferative index, and/or lactate dehydrogenase [LDH] level 600 U/L [normal range, 25225 U/L]) receive 16 IT methotrexate treatments. […] Patients with low LDH level and unknown proliferative index receive eight treatments of intrathecal methotrexate.

• #36 Acute Lymphoblastic Leukemia (ALL) Treatment Protocols: Treatment Protocols

  https://emedicine.medscape.com/article/2004705-overview

  Patients with ALL have an increased chance of CNS involvement; therefore, intrathecal (IT) methotrexate is given as CNS prophylaxis. […] CNS prophylaxis consists of methotrexate 12 mg IT on day 2 and cytarabine 100 mg IT on day 8 of each cycle, or similar regimens. […] Patients with a high risk for CNS disease (mature B-cell, high proliferative index, and/or lactate dehydrogenase [LDH] level 600 U/L [normal range, 25225 U/L]) receive 16 IT methotrexate treatments. […] Patients with low LDH level and unknown proliferative index receive eight treatments of intrathecal methotrexate.

• #37 Prophylaxis and treatment of acute lymphoblastic leukemia relapse afte | OTT

  https://www.dovepress.com/prophylaxis-and-treatment-of-acute-lymphoblastic-leukemia-relapse-afte-peer-reviewed-fulltext-article-OTT

  Relapse of acute lymphoblastic leukemia remains a major cause of death in patients following allogeneic hematopoietic stem cell transplantation. […] The mainstay of relapse prevention and treatment is donor leukocyte infusions, targeted therapies, second transplantation, and other novel therapies. […] We also make recommendations for critical strategies to prevent relapse after transplantation and challenges that must be addressed to ensure success. […] Patient survival is greatest when relapse does not occur post-allo-HSCT, so early detection of relapse and prediction of relapse based on contributing factors is the best approach for overall patient survival. […] The GVL effect in ALL is probably one of the most potent strategies with curative potential, and DLI is an attractive option for prophylaxis against relapse of ALL after transplantation.

• #38 Prophylaxis and treatment of acute lymphoblastic leukemia relapse afte | OTT

  https://www.dovepress.com/prophylaxis-and-treatment-of-acute-lymphoblastic-leukemia-relapse-afte-peer-reviewed-fulltext-article-OTT

  Relapse of acute lymphoblastic leukemia remains a major cause of death in patients following allogeneic hematopoietic stem cell transplantation. […] The mainstay of relapse prevention and treatment is donor leukocyte infusions, targeted therapies, second transplantation, and other novel therapies. […] We also make recommendations for critical strategies to prevent relapse after transplantation and challenges that must be addressed to ensure success. […] Patient survival is greatest when relapse does not occur post-allo-HSCT, so early detection of relapse and prediction of relapse based on contributing factors is the best approach for overall patient survival. […] The GVL effect in ALL is probably one of the most potent strategies with curative potential, and DLI is an attractive option for prophylaxis against relapse of ALL after transplantation.

• #39 Prophylaxis and treatment of acute lymphoblastic leukemia relapse afte | OTT

  https://www.dovepress.com/prophylaxis-and-treatment-of-acute-lymphoblastic-leukemia-relapse-afte-peer-reviewed-fulltext-article-OTT

  Modulation of immunosuppression may reduce relapse risk and improve ultimate outcome. […] Administration of imatinib early after allo-HSCT could be an effective approach for preventing recurrent Ph+ ALL. […] Interleukin-2 could be a safe and effective strategy to prevent relapse in ALL patients with a high risk of recurrence after unmodified allo-HSCT. […] Targeting these mutated genes with specific treatments may be a possible strategy to prevent relapse. […] The prevention and treatment strategies for relapse of ALL after allo-HSCT continue to evolve, with advancing developments using a variety of novel approaches.

• #40 Tertiary Prevention and Treatment for Reducing Leukemia Relapse

  https://www.scientificarchives.com/article/tertiary-prevention-and-treatment-for-reducing-leukemia-relapse

  We have found little available information in the medical literature on the prevention and treatment of tertiary leukemia or patients’ prognosis. […] From the perspective of prevention, there are four levels of disease onset and progression: primary, secondary, tertiary, and quaternary. Primary prevention aims to prevent the initiation of illness or injury; examples include immunization to prevent infections associated with the development of leukemia and avoiding exposure to known risk factors, such as certain chemicals or ionizing radiation. […] Tertiary prevention focuses on reducing the effects of the disease once it has been established, rehabilitation after significant illness, and prevention of comorbidity. […] Tertiary prevention of leukemia includes the use of chemotherapy and other treatments aiming for its control or remission, as well as supportive care measures to minimize the side effects of treatment and improve the patients overall well-being.

• #41 Tertiary Prevention and Treatment for Reducing Leukemia Relapse

  https://www.scientificarchives.com/article/tertiary-prevention-and-treatment-for-reducing-leukemia-relapse

  Given the nature of leukemia, it is difficult to follow the standards of each level of prevention perfectly. However, the primary and tertiary levels have been substantially addressed. […] It is recommended that high doses of radiation, exposure to benzene, smoking or other tobacco use, and obesity/obesity-related lifestyles be avoided to decrease ones chances of developing leukemia. […] Although we found limited information in our literature search specific to tertiary prevention of leukemia and its relapse, we understand the potential bias of the search strategy we used in terms of the possibility of missing relevant articles with the limited data sources we searched. However, continuing research into more innovative treatments is needed to prolong the lifespan for all patients with leukemia. Further, we call for more research on immunotherapies to explore their effectiveness in tertiary and quaternary prevention of leukemias in populations of even more diverse age groups, including the elderly.

• #42 Tertiary Prevention and Treatment for Reducing Leukemia Relapse

  https://www.scientificarchives.com/article/tertiary-prevention-and-treatment-for-reducing-leukemia-relapse

  We have found little available information in the medical literature on the prevention and treatment of tertiary leukemia or patients’ prognosis. […] From the perspective of prevention, there are four levels of disease onset and progression: primary, secondary, tertiary, and quaternary. Primary prevention aims to prevent the initiation of illness or injury; examples include immunization to prevent infections associated with the development of leukemia and avoiding exposure to known risk factors, such as certain chemicals or ionizing radiation. […] Tertiary prevention focuses on reducing the effects of the disease once it has been established, rehabilitation after significant illness, and prevention of comorbidity. […] Tertiary prevention of leukemia includes the use of chemotherapy and other treatments aiming for its control or remission, as well as supportive care measures to minimize the side effects of treatment and improve the patients overall well-being.

• #43 Explore Acute Lymphoblastic Leukaemia Prevention Risk factors and Prevention Measures at HCG Oncology

  https://www.hcgoncology.com/types-of-cancers/acute-lymphoblastic-leukaemia-prevention/

  Maintaining a healthy body weight and making efforts to lose weight if required may also play an important role in possible leukemia prevention. […] Staying physically active with regular exercises is also found to help lower the risk of developing ALL. […] Minimizing exposure to environmental pollutants can contribute to possible acute lymphoblastic leukemia prevention. […] Having a nutritious and balanced diet can surely contribute to possible acute lymphoblastic leukemia prevention. […] It is advised to drink only filtered water as an acute lymphoblastic leukemia prevention measure. […] Staying up-to-date with vaccinations helps strengthen a person’s immune system and lower the risk of acute lymphoblastic leukemia. […] It is highly recommended to practice appropriate sun safety measures for high-risk ALL prevention. […] Understanding the prevention and risk factors for ALL can greatly help in increasing the high-risk acute lymphoblastic leukemia survival rate among patients.

• #44 Tertiary Prevention and Treatment for Reducing Leukemia Relapse

  https://www.scientificarchives.com/article/tertiary-prevention-and-treatment-for-reducing-leukemia-relapse

  We have found little available information in the medical literature on the prevention and treatment of tertiary leukemia or patients’ prognosis. […] From the perspective of prevention, there are four levels of disease onset and progression: primary, secondary, tertiary, and quaternary. Primary prevention aims to prevent the initiation of illness or injury; examples include immunization to prevent infections associated with the development of leukemia and avoiding exposure to known risk factors, such as certain chemicals or ionizing radiation. […] Tertiary prevention focuses on reducing the effects of the disease once it has been established, rehabilitation after significant illness, and prevention of comorbidity. […] Tertiary prevention of leukemia includes the use of chemotherapy and other treatments aiming for its control or remission, as well as supportive care measures to minimize the side effects of treatment and improve the patients overall well-being.

• #45 Treatment for acute lymphoblastic leukaemia – NHS

  https://www.nhs.uk/conditions/acute-lymphoblastic-leukaemia/treatment/

  You may need to have treatment to prevent or control symptoms caused by acute lymphoblastic leukaemia. […] This may include: […] vaccines to help protect you from illnesses such as flu and COVID-19.

• #46 Chemotherapy for acute lymphoblastic leukaemia (ALL)

  https://www.cancerresearchuk.org/about-cancer/acute-lymphoblastic-leukaemia-all/treatment/chemotherapy-acute-lymphoblastic-leukaemia-all

  You have intrathecal chemotherapy to prevent leukaemia cells spreading to the CNS (CNS directed prophylaxis). […] You have extra intrathecal chemotherapy injections if: […] your doctor thinks you have a high risk of developing leukaemia in this area. […] The aims of the consolidation and intensification phases are to get rid of any leukaemia cells that might still be there and to reduce the risk of the leukaemia coming back. […] Having a growth factor such as G-CSF helps your white cell count go up more quickly. This could lower the risk of infection.

• #47 Leveraging Susceptible Populations and Unique Resources in a Pathway to Prevention of Childhood Acute Lymphoblastic Leukemia | Leukemia and Lymphoma Society

  https://www.lls.org/award/leveraging-susceptible-populations-and-unique-resources-pathway-prevention-childhood-acute

  The focus of my research is to understand the causes and early-life origins of acute lymphoblastic leukemia (ALL). […] Thus, prevention of childhood ALL remains the ultimate goal, but this will only be achievable by understanding its causes, by elucidating its natural history, and by identifying children with the greatest risk of developing ALL. […] The goals of my research program are to understand the causes of childhood ALL and how it first develops, and to lay the groundwork for prevention of this disease in at-risk children. […] Studying the variations in DNA that are associated with risk of ALL in these vulnerable children will shed light on the causes of ALL in the general population and will help us to identify children with the highest risk of developing ALL. […] Secondly, we aim to understand the early-life origins of ALL, capitalizing on the unique resources of the Childrens Oncology Group to collect banked cord blood samples from childhood ALL patients, which will allow us to examine which types of ALL develop during pregnancy, how the leukemia first develops many years prior to diagnosis, and what are the potential preventable risk factors for leukemia development in utero.

• #48 Leveraging Susceptible Populations and Unique Resources in a Pathway to Prevention of Childhood Acute Lymphoblastic Leukemia | Leukemia and Lymphoma Society

  https://www.lls.org/award/leveraging-susceptible-populations-and-unique-resources-pathway-prevention-childhood-acute

  Through these distinct but complementary research aims, we will gain a comprehensive knowledge of the genetic risk factors for childhood ALL so that we can identify children with the highest risk of developing the disease, and we will lay the groundwork towards newborn screening of leukemia and possible precision prevention strategies.

• #49 Tertiary Prevention and Treatment for Reducing Leukemia Relapse

  https://www.scientificarchives.com/article/tertiary-prevention-and-treatment-for-reducing-leukemia-relapse

  Given the nature of leukemia, it is difficult to follow the standards of each level of prevention perfectly. However, the primary and tertiary levels have been substantially addressed. […] It is recommended that high doses of radiation, exposure to benzene, smoking or other tobacco use, and obesity/obesity-related lifestyles be avoided to decrease ones chances of developing leukemia. […] Although we found limited information in our literature search specific to tertiary prevention of leukemia and its relapse, we understand the potential bias of the search strategy we used in terms of the possibility of missing relevant articles with the limited data sources we searched. However, continuing research into more innovative treatments is needed to prolong the lifespan for all patients with leukemia. Further, we call for more research on immunotherapies to explore their effectiveness in tertiary and quaternary prevention of leukemias in populations of even more diverse age groups, including the elderly.

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