Role of cytogenetic analysis in current management of childhood acute lymphoblastic leukemia treatment [Postavení cytogenetického vyšetrení v soucasném managementu lécby detské akutní lymfoblastické leukemie]
Abstract
Childhood acute lymphoblastic leukemia, like cancer in general, probably arises from interactions between exogenous or endogenous exposures, genetic susceptibility, and chance. This multistep process begins sometimes even during prenatal period of life.
Abnormal response to a common infection remains the strongest candidate for causal exposure. More precise risk stratification and personalized chemotherapy based on the biological characteristics of leukemic cells and hosts (prognostic and/or predictive genetic markers, minimal residual disease monitoring) have pushed the cure rate of childhood acute lymphoblastic leukemia to near 90 %.
However with the exception of infant leukemia, which still bears a dismal prognosis. Many new genetic techniques are approaching to clinical praxis mostly based on microarray or next-generation sequencing techniques.
The strong point of well-established cytogenetic analysis remains in the possibility of a complex view to the whole karyotype of pathological cells. This kind of view allows us to understand the origin of genetic abnormalities and diversity of cancer cells in the form of evolving new subclones.
The main goal of the presented case reports is to bring attention to this specific advantage of cytogenetic analysis.