Open Access Medical Books



Edited by Margarita Guenova and Gueorgui Balatzenko .

252 pages . 
Open Access .

Leukemias are a group of heterogeneous neoplastic disorders that differ significantly in terms of morhological, immunophenotypic, cytogenetic and molecular features of malignant cells. These specific features reflect the differences in the spectrum of underlying biological alterations involved in malignant transformation, and/or variations in the level of hematopoietic stem cells hierarchy where the transforming events occur. Classically, leukemias have been classified according to their cellular origin as myeloid or lymphoid, or according to their course as acute or chronic. During the last two decades a broad spectrum of sophisticated equipment and methods were implemented into the routine practice leading to a better understanding of the development of leukemias. This in term resulted in the invasion of new diagnostic criteria, definition of new entities and categories, introduction of novel therapeutic strategies, as well as improved monitoring of theatment effectiveness.
The continuous and rather extensive influx of new information regarding the pathogenesis and treatment of leukemias requires a frequent updating of this topic. The primary objective of this book is to provide the specialists involved in the diagnosis and management of acute and chronic leukemias with comprehensive and concise information on some important theoretical and practical issues of the diagnosis, treatment and follow up of patients with leukemias.
An international panel of experts contribute their experience to an update of various aspects of leukemias. The recent development of the genome wide analysis has provided new and critical knowledge of genetic changes in leukemias. The first chapter concerns recent knowledge of genetic and molecular aberrations in acute lymphoblastic leukemias (ALL), describing risk groups, frequency of cytogenetic abnormalities and their relationship with the prognosis, copy number alterations and somatic mutations. The second chapter reviews the epidemiology, genetics, pathogenesis, classification, clinical presentation, laboratory findings, differential diagnosis, treatment and prognosis in ALL in children. The third chapter summarizes the major signs, symptoms and laboratory features in acute leukemia. While acute leukemia patients depend on the expert recommendations from their physicians, knowledge of clinical presentation and patient's related prognostic factors can help to improve treatment decision and to identify patients who would benefit most from either intensive or low-intensive treatment or even best supportive care alone. Later in the book, therapy related acute myeloid leukemias are covered, emphasizing, on one side, that these represent the most serious long-term complications to current cancer therapy and the understanding would help to identify patients at risk in order to tailor therapy; while, on the other – that there is clinical and biological overlap between therapy related and high-risk de novo leukaemias suggesting similar mechanisms of leukaemogenesis. Deeper insights into pathogenetic mechanisms will eventually help to establish a more differentiated clinical approach to successfully treat, but hopefully also prevent, these often fatal consequences of cytotoxic therapies.

The advances in basic knowledge on leukemias provide clinicians with important understanding and improved decision making towards the most suitable therapy. Biochemical, structural, and genetic studies may have brought a new era of epigenetic based and immunomodulatory drugs that will form the basis for novel treatment strategies, presented in the fifth chapter of the book. Besides, treatment response is increasingly evaluated with minimal residual disease (MRD) assays. In the past years, there has been growing attention towards understanding the clinical relevance of MRD assessment. The monitoring of MRD levels at various stages of therapy has considerable potential to impact the guidance of treatment for AML patients and improve outcomes. Chapter six presents a comprehensive overview of the methodological approaches for MRD detection, the clinical applications and future directions for improvement of and alternatives for bone marrow MRD detection, including leukemic stem cell targeted therapies. The last chapter covers modern therapies in patients with chronic myeloid leukemia (CML) as one of the best investigated and undoubtedly best understood leukemias today. Current targeted drugs have changed not only the way we treat CML, but it has also changed the approach to developing new cancer drugs.
Each chapter is a separate publication that reflects each author´s views and concepts. However, the book presents a multi-faceted picture of our current understanding of the biology and clinical presentation, the diagnostic and therapeutic challenges in patients with leukemias.

Prof. Dr. Margarita Guenova, MD, PhD
Laboratory of Haemathopathology and Immunology,
National Specialised Hospital for Active Treatment of Haematological Diseases,
Sofia, Bulgaria

Prof. Dr. Gueorgui Balatzenko, MD, PhD
Laboratory of Cytogenetics and Molecular Biology,
National Specialised Hospital for Active Treatment of Haematological Diseases,
Sofia, Bulgaria



 1 Genetics of Acute Lymphoblastic Leukemia 1 Ruth Maribel Forero, María Hernández and Jesús María Hernández- Rivas

 2 Acute Lymphoblastic Leukemia in Children 39 Jelena Roganovic

 3 Acute Leukemia Clinical Presentation 75 Gamal Abdul Hamid

 4 Therapy-Related Acute Myeloid Leukemias 99 Margarita Guenova, Gueorgui Balatzenko and Georgi Mihaylov

 5 Treatment of Myelodysplastic Syndrome and Acute Myeloid Leukemia by Immunomodulatory and Epigenetic Drugs 157 Ota Fuchs

 6 Minimal Residual Disease and Leukemic Stem Cells in Acute Myeloid Leukemia 195 W. Zeijlemaker and G.J. Schuurhuis

 7 Modern Therapy of Chronic Myeloid Leukemia 227 M.M. Zaharieva, G. Amudov, S.M. Konstantinov and M. L. Guenova

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