Pathogenesis of pediatric B‑cell acute lymphoblastic leukemia: Molecular pathways and disease treatments (Review)
- Fang‑Liang Huang
- En‑Chih Liao
- Chia‑Ling Li
- Chung‑Yang Yen
- Sheng‑Jie Yu
Affiliations: Children's Medical Center, Taichung Veterans General Hospital, Xitun, Taichung 40705, Taiwan, R.O.C., Department of Medicine, Mackay Medical College, Sanzhi, New Taipei 252, Taiwan, R.O.C., Department of Dermatology, Taichung Veterans General Hospital, Xitun, Taichung 40705, Taiwan, R.O.C., Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Zuoying, Kaohsiung 813, Taiwan, R.O.C.
- Published online on: May 4, 2020 https://doi.org/10.3892/ol.2020.11583
Copyright: © Huang
et al. This is an open access article distributed under the
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B‑cell acute lymphoblastic lymphoma (B‑ALL) is a disease found mainly in children and in young adults. B‑ALL is characterized by the rapid proliferation of poorly differentiated lymphoid progenitor cells inside the bone marrow. In the United States, ~4,000 of these patients are diagnosed each year, accounting for ~30% of childhood cancer types. The tumorigenesis of the disease involves a number of abnormal gene expressions (including TEL‑AML1, BCR‑ABL‑1, RAS and PI3K) leading to dysregulated cell cycle. Risk factors of B‑ALL are the history of parvovirus B 19 infection, high birth weight and exposure to environmental toxins. These risk factors can induce abnormal DNA methylation and DNA damages. Treatment procedures are divided into three phases: Induction, consolidation and maintenance. The goal of treatment is complete remission without relapses. Apart from traditional treatments, newly developed approaches include gene targeting therapy, with the aim of wiping out leukemic cells through the inhibition of mitogen‑activated protein kinases and via c‑Myb inhibition enhancing sensitivity to chemotherapy. To evaluate the efficacy of ongoing treatments, several indicators are currently used. The indicators include the expression levels of microRNAs (miRs) miR‑146a, miR‑155, miR‑181a and miR‑195, and soluble interleukin 2 receptor. Multiple drug resistance and levels of glutathione reductase can affect treatment efficacy through the increased efflux of anti‑cancer drugs and weakening the effect of chemotherapy through the reduction of intracellular reactive oxygen species. The present review appraised recent studies on B‑ALL regarding its pathogenesis, risk factors, treatments, treatment evaluation and causes of disease relapse. Understanding the mechanisms of B‑ALL initiation and causes of treatment failure can help physicians improve disease management and reduce relapses.