Novel Aspects of Leukemia Pharmacogenomics
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ABSTRACT
Acute lymphoblastic leukemia (ALL) is the most common type of leukemia in children between the ages of 2 and 6. It is more frequent in boys than in girls. Currently, the overall cure rate of childhood ALL is approximately 75–80%. Integrated genomic analyses of patients with ALL have advanced the knowledge of the biological basis of ALL and have contributed to identifying subtypes, dysregulated pathways, and therapeutic targets that have resulted in the assignment of stratification categories and improvement of treatment strategies. Genomic studies in pediatric ALL patients have demonstrated chromosomal alterations during the evolution of the disease that directly influence the response to treatment and prognosis. Hence, the proper stratification of patients for identifying risks to prescribe the best treatment is crucial in the management of patients with ALL. Current risk stratification and treatment algorithms include cytogenetic alterations, clinical parameters, and levels of minimal residual disease. All these features are integrated to establish the clinical management of patients with ALL for surveillance of treatment success or for the identification of alternative therapeutic approaches. This chapter focuses on the genetic variations that affect the response to most of the chemotherapy drugs used for ALL.
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