الفهرس 
Acknowledgement
Clonal origin of leukemic lymphoid cells:Only 14 pages are availabe for public view
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Abstract
Acute lymphoblastic leukemia (ALL) is a complex and potentially curable hematopoietic cancer that has provided numerous firsts in the treatment of malignant disease for children and adults alike. ALL is the most common childhood acute leukemia, representing about 80% of acute leukemias, it comprises only 20% of adult leukemias. It has a bimodal age distribution. ALL is a heterogeneous group of lymphoid disorders that result from a monoclonal proliferation and expansion of immature lymphoid cells in the bone marrow, blood, and other organs. Better understanding of the biology of ALL has led to changes of the pathologic classification of the disease, the emergence of new therapies, and the institution of risk adapted therapies. Patients with ALL present most frequently with signs and symptoms of the uncontrolled growth of leukemic cells in bone marrow, lymphoid organs, and other sites of extramedullary spread. The diagnostic evaluation of a patient with acute leukemia is a comprehensive process that includes a detailed history and complete physical examination, morphologic and laboratory assessment of peripheral blood and bone marrow, blood chemistries, comprehensive clotting studies, a lumbar puncture and cerebrospinal fluid (CSF) examination, radiology, and other studies. Treatment for adult ALL is modeled on therapy developed for childhood ALL and consists of remission induction, consolidation, maintenance therapy, and CNS prophylaxis, using a risk- stratified approach. Allogeneic transplantation has remained a viable proposition in some clinical circumstances as it is seen to be the most effective anti-leukemic modality of all, better than any chemotherapy, passive antibody-induced immunotherapy or autologous transplantation. The prognostic importance of minimal residual disease (MRD) has been clearly demonstrated in adult ALL. Therefore, the goal of novel therapies has been to eradicate MRD. One approach has been to further intensify chemotherapy, such as with Southwest Oncology Group (SWOG) S0333 trial, a double-induction chemotherapy regimen. Another approach has been to use biologic and molecular features of leukemia cell as targets for therapy.