Current views on relapses of acute leukemia in children: A literature review
DOI:
https://doi.org/10.37800/RM.2.2026.748Keywords:
children, acute leukemia, relapse, measurable residual disease, immunophenotype, therapyAbstract
Relevance: Despite a substantial increase in remission rates and survival among children with acute lymphoblastic leukemia and acute myeloid leukemia, relapse remains one of the main causes of treatment failure. Relapse reflects the persistence of a residual leukemic clone, clonal evolution, and the development of drug resistance, necessitating repeated risk stratification and revision of therapeutic strategies.
The study aimed to analyze the available data on the onset, localization, clinical and biological characteristics and prognostically significant factors of relapses of acute leukemia in children to substantiate modern approaches to risk stratification and the choice of optimal therapy.
Materials and Methods: A literature review was performed based on the bibliographic sources provided by the author, followed by the selection of the 50 most relevant publications. The analysis included systematic reviews, clinical studies, consensus documents, and papers addressing measurable residual disease (MRD), molecular mechanisms of relapse, immunophenotypic evolution of the tumor, and current treatment strategies.
Results: The most significant prognostic factors after the first relapse are the time to relapse, the localization of the process, achievement of second remission, and measurable residual disease status after reinduction. Early, bone marrow, and combined relapses are associated with a less favorable prognosis than late and isolated extramedullary relapses. Contemporary studies show that relapses in children are accompanied by immunophenotypic variability, acquisition of new molecular abnormalities, and selection of resistant subclones. Therefore, patient management should include repeated morphological, immunological, and molecular genetic characterization of the tumor. Anti-relapse therapy increasingly relies on a risk-adapted approach that includes high-dose chemotherapy, immunotherapy, hematopoietic stem cell transplantation, and, in selected cases, cellular and targeted technologies.
Conclusion: Relapses of acute leukemias in children represent a heterogeneous group of conditions requiring a personalized choice of therapy and a more refined integration of clinical, MRD, and molecular criteria. Promising directions include standardization of MRD monitoring, early detection of clonal evolution, and broader implementation of immunotherapeutic and targeted strategies.
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