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research spotlight
phenotype of senescence, inflammation, and much as feasibly possible.
telomere shortening similar to that observed
in individuals three decades older. One in Prophylactic cranial radiotherapy, once
five of our survivors had already developed a standard component of childhood ALL
overt metabolic syndrome, whereas 50% therapy, has almost universally been replaced
demonstrated >1 abnormal metabolic by intrathecal and systemic methotrexate to
parameters such as hypertension, dyslipidemia reduce radiation-associated late effects. In
or elevated blood glucose (Ariffin, 2017). the MASPORE-ALL2003 protocol, only 15% of
patients received irradiation. The MASPORE-
Whilst a high survival rate is the aim and ALL2010 clinical trial (currently has recruited
source of pride for every paediatric oncologist, approximately 450 children) takes this one
an ever-increasing pool of young adult CCS step further by excluding cranial irradiation
with debilitating chronic co-morbidities altogether, irrespective of risk category.
necessitates serious reconsiderations Additionally, for the standard-risk patients,
on treatment philosophy. One of the key anthracyclines which are implicated in the
mitigation strategies is to re-think how these development of cardiac failure and second
children are treated. Specifically, risk-adapted cancers, are also completely omitted.
chemotherapy protocols with avoidance of
irradiation, identification of novel molecular UMMC is a collaborating site for the
targets, and incorporation of small molecules European BMT-FORUM trial which removes
are continuously being designed and improved total body irradiation and also the alkylating
to minimize long-term organ toxicities as drug cyclophosphamide, hitherto ‘standard’

Photomicrograph of bone marrow (MGG, 200X). Despite almost identical morphology, lymphoblasts have heterogenous
biology. Children with ALL require individualized therapy to achieve a balance between cure and toxicity.

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