Cancer
Tertiary prevention in leukemia patients: a literature review Nikita Manyak* Nikita Manyak Mingyi Chen Su Yon Jung
Background: After an extensive search, a literature gap in the tertiary prevention of leukemia patients and discussions on prognosis was identified. To address this, we conducted a comprehensive literature review, focusing on the last decade’s publications.
Method: Utilizing MEDLINE and PubMed electronic databases, we performed a thorough search using key terms “progression-free survival (PFS) leukemia,” restricting results to the English language within the last decade. From the initial 1,083 papers, relevant data and treatment recommendations for leukemia patients were extracted.
Results: Standard treatments like Daunorubicin, Doxorubicin, or Asparaginase for children, adolescents, and young adults (18 to 24 years) showed high relapse rates and complications within 5 years post-treatment. Notably, Blinatumomab and Ibrutinib-Rituximab demonstrated higher success rates in PFS and overall survival compared to other chemotherapy options. Two-year disease-free survival was 39.0% with intensive chemotherapy, whereas it rose to 54.4% with anticancer drugs. Additionally, patients treated with radiotherapy after relapse exhibited better long-term prevention of relapse and higher overall survival rates of 77.7% in comparison to the 11.3% in patients not treated with radiotherapy. For most pediatric leukemias, allogenic stem cell therapies have been found to be the most effective treatment with a higher rate of remission. In particular, Tisagenlecleucel, a chimeric antigen receptor (CAR) T-cell therapy, has been approved to treat pediatric leukemias when they have relapsed after initial or tertiary remission with a 5 or 10 year survival rate of 50%.
Conclusion: In the decade-long study of standard leukemia treatments for children and adolescents, CAR T-cell immunotherapy emerges as the most effective post-relapse option. Further research is warranted on immunotherapies across diverse age groups from a tertiary prevention perspective.