Issn Print: 0192-8562
Publication Date: 2001/10/01
Comments From the Editor-in-Chief
Excerpt
This edition of the Journal of Pediatric Hematology/Oncology features several articles and a commentary concerning acute lymphoblastic leukemia (ALL). The commentary by Dr. Ching-Hon Pui discusses the issue of risk assessment and the prediction of outcome in pediatric patients with ALL based in part on the article by Dr. Felice et al. They raise important questions as to whether presenting clinical features such as early response and various biomarkers are sufficient to predict outcome in ALL. For a disease in which such extraordinary success has been achieved, it is of interest, as Dr. Pui points out, that approximately one-third of patients with standard-risk ALL experience a significant adverse event, usually meaning relapse. In patients at high risk, it remains unclear how best to improve therapeutic outcomes and what role hematopoietic stem cell transplantation plays. Clearly, early response to therapy as emphasized by the commentary and the article by Felice are important. However, like many other prognostic factors, response to therapy lacks the specific sensitivity and specificity to definitively predict the best therapy and/or outcome for individual patients. Prognostic factors thus far remain inadequate predictors of which individual therapy is best and how well it will work in terms of overall outcome. We need to better understand the immense number of factors related to both the leukemia and the host to develop definitive predictors of response and outcome in individual patients. How quixotic such a goal is remains unclear, even with the detailed expression, functional, and genotype mapping that are becoming available. However, acquiring the ability to individualize therapies will have other consequences, especially in the manner in which we perform investigative clinical trials.
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