Fast Five Quiz: B-Cell Acute Lymphoblastic Leukemia
What do you know about B-ALL? Check your knowledge with this quick quiz.
The treatment of B-ALL involves a complex and intensive series of steps. In the induction phase, glucocorticoids are typically used to reduce tumor burden by clearing leukemic cells from the bone marrow. However, point mutations in the NR3C1 gene generally cause resistance to glucocorticoid therapy, which can significantly affect prognosis. Mutations in the CREBBP gene also cause resistance to glucocorticoids
DHFR , FPGS , and TYMS genes have been shown to generally cause resistance to methotrexate, not glucocorticoids.
Learn more about corticosteroids in B-ALL.
In risk stratification for B-ALL, the NCCN notes that having a white blood cell count of > 30 x 109/L is considered a high-risk feature. This is consistent with European guidelines. The NCCN also states that age over 35 years is another high-risk feature for B-ALL. ETP phenotype is a high-risk feature for T-cell acute lymphoblastic leukemia rather than the B-ALL subtype. Hyperdiploidy (a molecular subtype of B-ALL with 51-65 chromosomes) is considered standard risk by the NCCN; data have shown better prognosis for pediatric patients with this subtype.
Learn more about risk stratification for B-ALL.
TKIs are an important component of induction, consolidation, and maintenance treatment for Ph+ B-ALL. They are recommended by the NCCN for use in conjunction with other drugs, such as corticosteroids, blinatumomab, and inotuzumab ozogamicin (depending on treatment phase and disease severity) and as a treatment post-HCT. They recommend continuing TKI therapy for at least 2 years after HCT, although they note that the 'optimal duration' is unknown for this population.
A recent review, however, notes that despite their success in patients with Ph+ B-ALL, approximately 25% of cases will develop resistance to TKIs. Given this possibility, the NCCN notes that clinicians should consider prior TKI intolerance, dose used, BCR::ABL1 mutations, and disease-related features when choosing a specific TKI; they specifically recommend bosutinib, dasatinib, imatinib, nilotinib, or ponatinib as options for TKI therapy.
Learn more about Ph+ B-ALL treatments.
The DUX4-rearranged subtype of B-ALL is considered to have a favorable prognosis in adolescents and young adults, compared with MEF2D-rearranged, CDX2/UBTF, and IDH1/2; these subtypes generally have inferior prognosis in the same populations (although MEF2D-rearranged has intermediate prognosis in adults). Specifically, DUX4-rearranged B-ALL has been associated with 93% event-free survival and overall survival in pediatric patients, and adolescent and young-adult patients also see longer disease-free survival after complete remission is achieved.
Learn more about B-ALL genomics.
Several genetic subtypes of B-ALL are associated with varying prognoses, and the outcomes differences seen between pediatric and adult patients can be partly explained by the different subtypes expressed by these populations. Further, new therapies have enabled high survival rates among pediatric patients with B-ALL, with long-term survival of up to 90% in this population. Prognosis for B-ALL in adolescents and adults is comparatively poor. For example, a population-based study reported the following declining survival rates with age: 74% for patients 15-19 years old, 59% for patients 20-39 years old, and 43% for those 40-59 years old. However, the researchers explained that these percentages still demonstrate improvements, as survival rates were overall lower in the 1980s and 1990s.
Learn more about B-ALL prognosis.
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
USA Today
4 hours ago
- USA Today
Sophie Cunningham injury update: Fever guard will miss rest of season with knee injury
The Indiana Fever overcame a 21-point deficit to defeat the Connecticut Sun in overtime on Sunday, but the victory proved to be bittersweet as guard Sophie Cunningham exited with a knee injury, an unfortunate circumstance that has become all too familiar for the Fever this season. On Tuesday, the Fever announced Cunningham's first season with the team is over after, sources told the Indy Star, part of USA TODAY network, she suffered a torn MCL in her right knee. The Fever added that Cunningham is expected to make a full recovery. The incident happened early in the second quarter when Sun guard Bria Hartley fell into Cunningham's right knee while trying to drive the basket. Cunningham grabbed her right leg and hopped to the baseline, then fell to the floor, grabbing her knee and yelling in pain. The Fever called timeout and Cunningham was quickly surrounded by her teammates, who held up towels to shield her from the crowd. She was eventually helped off the floor and to the locker room and did not return. Cunningham, who turned 29 on Aug. 16, was held scoreless (0-of-3 FG, 0-of-3 3PT) in 10 minutes of play before exiting. She's averaging 8.9 points and 3.6 rebounds in 30 games this season for the Fever, while shooting a career-high 46.9% from the field and a career-high 43.2% from the field. SOPHIE CUNNINGHAM: Fever guard has knee injury, knocked from Sun game Cunningham's injury marks the latest blow in the Fever's injury-plagued season. All-Star point guard Caitlin Clark has missed 22 of the Fever's 35 games this season due to various injuries, including a right groin injury that has kept her sidelined for 13 consecutive games. The Fever lost guards Sydney Colson (left ACL tear) and Aari McDonald (broken right foot) to season-ending injuries in the Fever's 107-101 win against the Phoenix Mercury, further depleting the team's backcourt. "It was a quick turnaround, figuring out how we were going to play without Aari (McDonald) and Syd (Colson) and now we have to figure out how we're going to play without Soph (Cunningham)," Fever head coach Stephanie White said on Sunday after her team's overtime win. To make matters worse, the Fever's schedule doesn't get any easier down the final stretch. The Fever will host the defending champion Minnesota Lynx on Aug. 22, before traveling to Minneapolis to take on the Lynx again on Aug. 24. The Fever also have upcoming matchups against Seattle (Aug. 26), Los Angeles (Aug. 29) and Golden State (Aug. 31). Indiana is currently in playoff contention in sixth place at 19-16 on the season. To address Indiana's glaring need at the point guard position, the Fever signed guard Odyssey Sims to a hardship contract on Aug. 10 and an additional seven-day hardship contract on Aug. 17. Indiana also signed guard Kyra Lambert to a seven-day contract on Aug. 14. Following the news of Cunningham's injury, the Fever signed guard Shey Peddy to a seven-day hardship contract and released Lambert. White got emotional talking about her team's resilience and constant struggle with injuries. "They're good human beings, they're selfless, they're tough ... They just got something inside of them that you can't teach and they bring it out of each other. It allows us to go through these incredibly tough times that we're going through and always gives us a chance," White said. "I'm just so incredibly proud of them for continuing to believe and for continuing to pull together and for continuing to step up." Contributing: Steve Gardner The USA TODAY app gets you to the heart of the news — fast. Download for award-winning coverage, crosswords, audio storytelling, the eNewspaper and more.
Yahoo
11 hours ago
- Yahoo
Watch the video: Which EU countries are leading on access to contraceptives?
Access to effective and affordable contraception remains highly unequal across Europe — but most countries are heading in the right direction. The latest Contraception Policy Atlas by the European Parliamentary Forum for Sexual and Reproductive Rights (EPF) shows that 22 out of 47 countries now include contraceptives in their national health systems. Counselling services are also covered in all of them except Austria. The report also notes that nearly a quarter of European countries provide high-quality, government-run websites offering clear information about contraception. In 17% of countries, emergency contraception is available free of charge at pharmacies or public health centres. Western Europe continues to lead in access. France and Luxembourg are at the top of the ranking with scores of 93.2%, followed closely by the United Kingdom (91.6%), Portugal (91.2%), and Belgium (90.3%). At the other end of the scale are Poland (33.2%), Hungary (40%), Cyprus (42.1%), Slovakia (44%), and Greece (49%) — all ranked among the lowest in access. The researchers who compiled the 2025 Atlas recognised the policy developments in countries such as Austria, Ireland, and Luxembourg. They also recommended that policymakers extend coverage, enhance counselling services (particularly in rural and remote areas), and monitor the development of new technologies to combat misinformation and guarantee reproductive autonomy for all Europeans. According to the latest available figures, 8.5% of women in Europe aged 15–49 want to stop or delay having children, but are not using contraception.
Yahoo
11 hours ago
- Yahoo
Using AI Made Doctors Worse at Spotting Cancer Without Assistance
Credit - Getty Images Health practitioners, companies, and others have for years hailed the potential benefits of AI in medicine, from improving medical imaging to outperforming doctors at diagnostic assessments. The transformative technology has even been predicted by AI enthusiasts to one day help find a 'cure to cancer.' But a new study has found that doctors who regularly used AI actually became less skilled within months. The study, which was published on Wednesday in the Lancet Gastroenterology and Hepatology journal, found that over the course of six months, clinicians became over-reliant on AI recommendations and became themselves 'less motivated, less focused, and less responsible when making cognitive decisions without AI assistance.' It's the latest study to demonstrate potential adverse outcomes on AI users. An earlier study by the Massachusetts Institute of Technology found that ChatGPT eroded critical thinking skills. How the study was conducted Researchers across various European institutions conducted an observational study surveying four endoscopy centers in Poland that participated in the Artificial Intelligence in Colonoscopy for Cancer Prevention (ACCEPT) trial. The study was funded by the European Commission and Japan Society for the Promotion of Science. As part of the trial, the centers had introduced AI tools for the detection of polyps—growths that can be benign or cancerous—in late 2021. The study looked at 1,443 non-AI-assisted colonoscopies out of a total 2,177 colonoscopies conducted between September 2021 and March 2022. The colonoscopies were performed by 19 experienced endoscopists. Researchers compared the quality of colonoscopy conducted three months before and three months after AI was implemented. Colonoscopies were conducted either with or without AI assistance, at random. Of those conducted without AI assistance, 795 were conducted before regular AI use was implemented and 648 were conducted after the AI tools were introduced. What the study found Three months before AI was introduced, the adenoma detection rate (ADR) was around 28%. Three months after AI was introduced, the rate dropped to 22% when clinicians were unassisted by AI. ADR is a commonly used quality indicator for colonoscopies and represents 'the proportion of screening colonoscopies performed by a physician that detect at least one histologically confirmed colorectal adenoma or adenocarcinoma.' Adenomas are precancerous growths, and a higher ADR is associated with a lower risk of colorectal cancer. The study found that AI did help endoscopists with detection when used, but once the assistance was removed, clinicians were worse at detection. Researchers attributed it to 'the natural human tendency to over-rely' on the recommendations of decision support systems like AI. 'Imagine that you want to travel anywhere, and you're unable to use Google Maps,' Marcin Romańczyk, co-author of the study and an assistant professor at the Medical University of Silesia, told MedPage Today. 'We call it the Google Maps effect. We try to get somewhere, and it's impossible to use a regular map. It works very similarly.' Implications of the study Omer Ahmad, a consultant gastroenterologist at University College Hospital London who wrote an editorial alongside the study but was not involved in its research, tells TIME that it's likely that exposure to AI weakened doctors' visual search habits and alerting gaze patterns, which are critical for detecting polyps. 'In essence, dependence on AI detection could dull human pattern recognition,' Ahmad says. He adds that regular use of AI could also 'reduce diagnostic confidence' when AI assistance is withdrawn, or that the endoscopists' skill of manoeuvring the colonoscope could be reduced. In comments to the Science Media Center (SMC), Catherine Menon, principal lecturer at the University of Hertfordshire's Department of Computer Science, said: 'Although de-skilling resulting from AI use has been raised as a theoretical risk in previous studies, this study is the first to present real-world data that might potentially indicate de-skilling arising from the use of AI in diagnostic colonoscopies.' Menon raised concerns that overreliance on AI could leave health practitioners at risk to technological compromise. Other experts are more cautious about drawing conclusions from a single study. Venet Osmani, a professor of clinical AI and machine learning at Queen Mary University of London, noted to SMC that the total number of colonoscopies—including both AI-assisted and non-AI-assisted ones—increased over the course of the study. The increased workload, Osmani suggested, could have led to clinician fatigue and poorer detection rates. Allan Tucker, a professor of artificial intelligence at Brunel University of London, also noted that with AI assistance, clinician performance improved overall. Concerns about deskilling due to automation bias, added Tucker to SMC, 'is not unique to AI systems and is a risk with the introduction of any new technology.' 'The ethical question then is whether we trust AI over humans,' said Tucker. 'Often, we expect there to be a human overseeing all AI decision-making but if the human experts are putting less effort into their own decisions as a result of introducing AI systems this could be problematic.' 'This is not simply about monitoring technology,' says Ahmad. 'It's about navigating the complexities of a new human-AI clinical ecosystem.' Establishing safeguards is critical, he adds, suggesting that beyond this study, people may need to focus on 'preserving essential skills in a world where AI becomes ubiquitous.' Contact us at letters@
