eMedicine Specialties > Hematology > Stem Cells and Disorders

Acute Lymphoblastic Leukemia: Follow-up

Author: Karen Seiter, MD, Professor, Department of Internal Medicine, Division of Oncology/Hematology, New York Medical College
Contributor Information and Disclosures

Updated: Feb 3, 2009

Follow-up

Further Inpatient Care

  • Patients with acute lymphoblastic leukemia (ALL) require admission for induction chemotherapy, and they require readmission for consolidation chemotherapy or for the treatment of toxic effects of chemotherapy.

Further Outpatient Care

  • Maintenance therapy is administered in an outpatient setting.
  • Patients come to the office to be monitored for disease status and the effects of chemotherapy.

Transfer

  • Patients with acute lymphoblastic leukemia (ALL) are best treated at a center with personnel who have significant experience in the treatment of leukemia.
  • Patients admitted to hospitals that lack appropriate blood product support facilities, leukapheresis capabilities, or physicians and nurses familiar with the treatment of patients with leukemia should be transferred to an appropriate (generally tertiary care) hospital.

Deterrence/Prevention

  • While taking chemotherapy, patients with leukemia should avoid exposure to crowds and people with contagious illnesses, especially children with viral infections.

Complications

  • Death in those with acute lymphoblastic leukemia (ALL) may occur as a result of uncontrolled infection or hemorrhage. This may occur even after the use of appropriate blood product and antibiotic support.
  • The most common complication is failure of the leukemia to respond to chemotherapy. These patients do poorly because they usually do not respond to other chemotherapy regimens.

Prognosis

  • Patients with acute lymphoblastic leukemia (ALL) are divided into the following 3 prognostic groups:
    • Good risk includes (1) no adverse cytogenetics, (2) age younger than 30 years, (3) WBC count of less than 30,000/μL, and (4) complete remission within 4 weeks.
    • Intermediate risk includes those whose condition does not meet the criteria for either good risk or poor risk.
    • Poor risk includes (1) adverse cytogenetics [(t9;22), (4;11)], (2) age older than 60 years, (3) precursor B-cell WBCs with WBC count greater than 100,000/μL, or (4) failure to achieve complete remission within 4 weeks.
      • Patients with precursor B-cell ALL have an extremely poor prognosis. Essentially, following standard chemotherapy or autologous transplantation, long-term survival is not achieved. Several reports have indicated that some patients with precursor B-cell ALL and t(4;11) may have prolonged survival following allogeneic transplantation; therefore, this is the treatment of choice.
  • The effect of immunophenotype on prognosis are as follows:
    • Czuczman et al studied 259 patients treated with several CALGB protocols for newly diagnosed acute lymphoblastic leukemia (ALL).32 B-lineage phenotype was expressed in 79% of patients; one third of these coexpressed myeloid antigens. Seventeen percent of patients demonstrated T-lineage ALL; one quarter of these coexpressed myeloid antigens. No significant difference in response rates, remission duration, or survival was observed for patients expressing myeloid antigens versus those not expressing myeloid antigens. T-lineage acute lymphoblastic leukemia (ALL) was associated with younger age, male sex, presence of a mediastinal mass, higher WBC count and hemoglobin level, longer survival, and longer disease-free survival. The number of T markers expressed also had prognostic significance. Patients expressing 6 or more markers had longer disease-free and overall survival compared with patients expressing 3 or fewer markers.
    • In a report by Preti et al, 64 of 162 patients with newly diagnosed acute lymphoblastic leukemia (ALL) coexpressed myeloid markers.33 Patients coexpressing myeloid markers were significantly older, had a higher prevalence of CD34 expression, and had a lower prevalence of common ALL antigen expression than patients without myeloid expression. A trend toward a decreased remission rate was observed for patients coexpressing myeloid markers (64%) as compared with those who did not coexpress such markers (78%) (P = 0.06). However, no significant effect on remission duration or overall survival was observed.
  • The effect of chromosome number on prognosis is displayed in Table 2.

Patient Education

  • Patients with acute lymphoblastic leukemia (ALL) should be instructed to immediately seek medical attention if they are febrile or have signs of bleeding.

Miscellaneous

Medicolegal Pitfalls

  • Patients with acute lymphoblastic leukemia (ALL) are best treated by physicians who have significant experience in the treatment of patients with acute leukemia. In addition, these patients should be treated in a setting where appropriate supportive care measures (high-level blood banking and leukapheresis) are available.
 


More on Acute Lymphoblastic Leukemia

Overview: Acute Lymphoblastic Leukemia
Differential Diagnoses & Workup: Acute Lymphoblastic Leukemia
Treatment & Medication: Acute Lymphoblastic Leukemia
Follow-up: Acute Lymphoblastic Leukemia
Multimedia: Acute Lymphoblastic Leukemia
References
Further Reading
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References

  1. Bogni A, Cheng C, Liu W, et al. Genome-wide approach to identify risk factors for therapy-related myeloid leukemia. Leukemia. Feb 2006;20(2):239-46. [Medline]. [Full Text].

  2. Fiere D, Archimbaud E, Extra JM, et al. Treatment of adult acute lymphoblastic leukemia. Preliminary results of a trial from the French Group. Haematol Blood Transfus. 1987;30:125-9. [Medline].

  3. Fiere D, Extra JM, David B, et al. Treatment of 218 adult acute lymphoblastic leukemias. Semin Oncol. Jun 1987;14(2 suppl 1):64-6. [Medline].

  4. Hoelzer D, Thiel E, Loffler H, et al. Intensified therapy in acute lymphoblastic and acute undifferentiated leukemia in adults. Blood. Jul 1984;64(1):38-47. [Medline]. [Full Text].

  5. Durrant IJ, Prentice HG, Richards SM, and the Medical Research Council Working Party on Leukaemia in Adults. Intensification of treatment for adults with acute lymphoblastic leukaemia: results of U.K. Medical Research Council randomized trial UKALL XA. Br J Haematol. Oct 1997;99(1):84-92. [Medline].

  6. Cuttner J, Mick R, Budman DR, et al. Phase III trial of brief intensive treatment of adult acute lymphocytic leukemia comparing daunorubicin and mitoxantrone: a CALGB Study. Leukemia. May 1991;5(5):425-31. [Medline].

  7. Dekker AW, van't Veer MB, Sizoo W, et al. Intensive postremission chemotherapy without maintenance therapy in adults with acute lymphoblastic leukemia. Dutch Hemato-Oncology Research Group. J Clin Oncol. Feb 1997;15(2):476-82. [Medline].

  8. Mandelli F, Annino L, Rotoli B, and the GIMEMA Cooperative Group, Italy. The GIMEMA ALL 0183 trial: analysis of 10-year follow-up. Br J Haematol. Mar 1996;92(3):665-72. [Medline].

  9. Cortes J, O'Brien SM, Pierce S, et al. The value of high-dose systemic chemotherapy and intrathecal therapy for central nervous system prophylaxis in different risk groups of adult acute lymphoblastic leukemia. Blood. Sep 15 1995;86(6):2091-7. [Medline]. [Full Text].

  10. Arlin ZA, Feldman EJ, Finger LR, et al. Short course high dose mitoxantrone with high dose cytarabine is effective therapy for adult lymphoblastic leukemia. Leukemia. Aug 1991;5(8):712-4. [Medline].

  11. Weiss M, Maslak P, Feldman E, et al. Cytarabine with high-dose mitoxantrone induces rapid complete remissions in adult acute lymphoblastic leukemia without the use of vincristine or prednisone. J Clin Oncol. Sep 1996;14(9):2480-5. [Medline].

  12. Hoelzer D, Ludwig WD, Thiel E, Gassmann W, Löffler H, Fonatsch C, et al. Improved outcome in adult B-cell acute lymphoblastic leukemia. Blood. Jan 15 1996;87(2):495-508. [Medline]. [Full Text].

  13. Thomas TA, Kantarjian H, Faderl S, et al. Update of the modified hyper-CVAD regimen with or without rituximab as frontline therapy of adults with acute lymphocytic leukemia (ALL) or lymphoblastic lymphoma (LL) [abstract]. Blood. 2007;110:2824a. [Full Text].

  14. Ludwig WD, Rieder H, Bartram CR, et al. Immunophenotypic and genotypic features, clinical characteristics, and treatment outcome of adult pro-B acute lymphoblastic leukemia: results of the German multicenter trials GMALL 03/87 and 04/89. Blood. Sep 15 1998;92(6):1898-909. [Medline]. [Full Text].

  15. Thomas DA, Faderl S, Cortes J, et al. Treatment of Philadelphia chromosome-positive acute lymphocytic leukemia with hyper-CVAD and imatinib mesylate. Blood. Jun 15 2004;103(12):4396-407. [Medline]. [Full Text].

  16. Kantarjian H, Giles F, Wunderle L, et al. Nilotinib in imatinib-resistant CML and Philadelphia chromosome-positive ALL. N Engl J Med. Jun 15 2006;354(24):2542-51. [Medline]. [Full Text].

  17. Talpaz M, Shah NP, Kantarjian H, et al. Dasatinib in imatinib-resistant Philadelphia chromosome-positive leukemias. N Engl J Med. Jun 15 2006;354(24):2531-41. [Medline]. [Full Text].

  18. Boissel N, Auclerc MF, Lheritier V, et al. Should adolescents with acute lymphoblastic leukemia be treated as old children or young adults? Comparison of the French FRALLE-93 and LALA-94 trials. J Clin Oncol. Mar 1 2003;21(5):774-80. [Medline]. [Full Text].

  19. Stock W, Sather H, Dodge RK, et al. Outcome of adolescents and young adults with ALL: a comparison of Children's Cancer Group (CCG) and Cancer and Leukemia Group B (CALGB) regimens [abstract]. Blood. 2000;96 (suppl):476a.

  20. Ribera JM, Ortega JJ, Oriol A, et al. Late intensification chemotherapy has not improved the results of intensive chemotherapy in adult acute lymphoblastic leukemia. Results of a prospective multicenter randomized trial (PETHEMA ALL-89). Spanish Society of Hematology. Haematologica. Mar 1998;83(3):222-30. [Medline]. [Full Text].

  21. Hunault M, Harousseau JL, Delain M, et al, for the GOELAMS (Groupe Ouest-Est des Leucemies Airgues et Maladies du Sang) Group. Better outcome of adult acute lymphoblastic leukemia after early genoidentical allogeneic bone marrow transplantation (BMT) than after late high-dose therapy and autologous BMT: a GOELAMS trial. Blood. Nov 15 2004;104(10):3028-37. [Medline]. [Full Text].

  22. Rowe JM, Buck G, Burnett AK, et al. Induction therapy for adults with acute lymphoblastic leukemia: results of more than 1500 patients from the international ALL trial: MRC UKALL XII/ECOG E2993. Blood. Dec 1 2005;106(12):3760-7. [Medline]. [Full Text].

  23. Martino R, Bellido M, Brunet S, et al. Allogeneic or autologous stem cell transplantation following salvage chemotherapy for adults with refractory or relapsed acute lymphoblastic leukemia. Bone Marrow Transplant. May 1998;21(10):1023-7. [Medline]. [Full Text].

  24. Weisdorf DJ, Billett AL, Hannan P, et al. Autologous versus unrelated donor allogeneic marrow transplantation for acute lymphoblastic leukemia. Blood. Oct 15 1997;90(8):2962-8. [Medline]. [Full Text].

  25. Kantarjian H, Gandhi V, Cortes J, et al. Phase 2 clinical and pharmacologic study of clofarabine in patients with refractory or relapsed acute leukemia. Blood. Oct 1 2003;102(7):2379-86. [Medline]. [Full Text].

  26. Kurtzberg J, Ernst TJ, Keating MJ, et al. Phase I study of 506U78 administered on a consecutive 5-day schedule in children and adults with refractory hematologic malignancies. J Clin Oncol. May 20 2005;23(15):3396-403. [Medline]. [Full Text].

  27. Geissler K, Koller E, Hubmann E, et al. Granulocyte colony-stimulating factor as an adjunct to induction chemotherapy for adult acute lymphoblastic leukemia--a randomized phase-III study. Blood. Jul 15 1997;90(2):590-6. [Medline]. [Full Text].

  28. Larson RA, Dodge RK, Linker CA, et al. A randomized controlled trial of filgrastim during remission induction and consolidation chemotherapy for adults with acute lymphoblastic leukemia: CALGB study 9111. Blood. Sep 1 1998;92(5):1556-64. [Medline]. [Full Text].

  29. Bassan R, Lerede T, Di Bona E, et al. Granulocyte colony-stimulating factor (G-CSF, filgrastim) after or during an intensive remission induction therapy for adult acute lymphoblastic leukaemia: effects, role of patient pretreatment characteristics, and costs. Leuk Lymphoma. Jun 1997;26(1-2):153-61. [Medline].

  30. Ifrah N, Witz F, Jouet JP, et al. Intensive short term therapy with granulocyte-macrophage-colony stimulating factor support, similar to therapy for acute myeloblastic leukemia, does not improve overall results for adults with acute lymphoblastic leukemia. GOELAMS Group. Cancer. Oct 15 1999;86(8):1496-505. [Medline]. [Full Text].

  31. Thomas X, Boiron JM, Huguet F, et al, and the Groupe d'Etude et de Traitement de la Leucemie Aigue Lymphoblastique de l'Adulte (GET-LALA Group). Efficacy of granulocyte and granulocyte-macrophage colony-stimulating factors in the induction treatment of adult acute lymphoblastic leukemia: a multicenter randomized study. Hematol J. 2004;5(5):384-94. [Medline].

  32. Czuczman MS, Dodge RK, Stewart CC, et al. Value of immunophenotype in intensively treated adult acute lymphoblastic leukemia: cancer and leukemia Group B study 8364. Blood. Jun 1 1999;93(11):3931-9. [Medline]. [Full Text].

  33. Preti HA, Huh YO, O'Brien SM, et al. Myeloid markers in adult acute lymphocytic leukemia. Correlations with patient and disease characteristics and with prognosis. Cancer. Nov 1 1995;76(9):1564-70. [Medline].

  34. Andersen MK, Christiansen DH, Jensen BA, et al. Therapy-related acute lymphoblastic leukaemia with MLL rearrangements following DNA topoisomerase II inhibitors, an increasing problem: report on two new cases and review of the literature since 1992. Br J Haematol. Sep 2001;114(3):539-43. [Medline].

  35. Attal M, Blaise D, Marit G, et al. Consolidation treatment of adult acute lymphoblastic leukemia: a prospective, randomized trial comparing allogeneic versus autologous bone marrow transplantation and testing the impact of recombinant interleukin-2 after autologous bone marrow transplantation. BGMT Group. Blood. Aug 15 1995;86(4):1619-28. [Medline]. [Full Text].

  36. Druker BJ, Sawyers CL, Kantarjian H, et al. Activity of a specific inhibitor of the BCR-ABL tyrosine kinase in the blast crisis of chronic myeloid leukemia and acute lymphoblastic leukemia with the Philadelphia chromosome. N Engl J Med. Apr 5 2001;344(14):1038-42. [Medline]. [Full Text].

  37. Ellison RR, Mick R, Cuttner J, et al. The effects of postinduction intensification treatment with cytarabine and daunorubicin in adult acute lymphocytic leukemia: a prospective randomized clinical trial by Cancer and Leukemia Group B. J Clin Oncol. Nov 1991;9(11):2002-15. [Medline].

  38. Fiere D, Lepage E, Sebban C, et al, for the French Group on Therapy for Adult Acute Lymphoblastic Leukemia. Adult acute lymphoblastic leukemia: a multicentric randomized trial testing bone marrow transplantation as postremission therapy. J Clin Oncol. Oct 1993;11(10):1990-2001. [Medline].

  39. Giona F, Annino L, Rondelli R, et al. Treatment of adults with acute lymphoblastic leukaemia in first bone marrow relapse: results of the ALL R-87 protocol. Br J Haematol. Jun 1997;97(4):896-903. [Medline].

  40. Group Francais de Cytogenetique Hematologique. Cytogenetic abnormalities in adult acute lymphoblastic leukemia: correlations with hematologic findings outcome. A collaborative study of the Group Francais de Cytogenetique Hematologique. Blood. Apr 15 1996;87(8):3135-42. [Medline]. [Full Text].

  41. Han X, Bueso-Ramos CE. Advances in the pathological diagnosis and biology of acute lymphoblastic leukemia. Ann Diagn Pathol. Aug 2005;9(4):239-57. [Medline].

  42. Kantarjian H, Thomas D, O'Brien S, et al. Long-term follow-up results of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (Hyper-CVAD), a dose-intensive regimen, in adult acute lymphocytic leukemia. Cancer. Dec 15 2004;101(12):2788-801. [Medline]. [Full Text].

  43. Kiehl MG, Kraut L, Schwerdtfeger R, et al. Outcome of allogeneic hematopoietic stem-cell transplantation in adult patients with acute lymphoblastic leukemia: no difference in related compared with unrelated transplant in first complete remission. J Clin Oncol. Jul 15 2004;22(14):2816-25. [Medline]. [Full Text].

  44. Koller CA, Kantarjian HM, Thomas D, et al. The hyper-CVAD regimen improves outcome in relapsed acute lymphoblastic leukemia. Leukemia. Dec 1997;11(12):2039-44. [Medline].

  45. Larson RA, Dodge RK, Burns CP, et al. A five-drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukemia: cancer and leukemia group B study 8811. Blood. Apr 15 1995;85(8):2025-37. [Medline]. [Full Text].

  46. Mancini M, Scappaticci D, Cimino G, et al. A comprehensive genetic classification of adult acute lymphoblastic leukemia (ALL): analysis of the GIMEMA 0496 protocol. Blood. May 1 2005;105(9):3434-41. [Medline]. [Full Text].

  47. Redaelli A, Laskin BL, Stephens JM, Botteman MF, Pashos CL. A systematic literature review of the clinical and epidemiological burden of acute lymphoblastic leukaemia (ALL). Eur J Cancer Care (Engl). Mar 2005;14(1):53-62. [Medline].

  48. Ribera JM, Oriol A, Sanz MA, et al. Comparison of the results of the treatment of adolescents and young adults with standard-risk acute lymphoblastic leukemia with the Programa Espanol de Tratamiento en Hematología pediatric-based protocol ALL-96. J Clin Oncol. Apr 10 2008;26(11):1843-9. [Medline].

  49. Rizzieri DA, Johnson JL, Niedzwiecki D, et al. Intensive chemotherapy with and without cranial radiation for Burkitt leukemia and lymphoma: final results of Cancer and Leukemia Group B Study 9251. Cancer. Apr 1 2004;100(7):1438-48. [Medline]. [Full Text].

  50. Sarris A, Cortes J, Kantarjian H, et al. Disseminated intravascular coagulation in adult acute lymphoblastic leukemia: frequent complications with fibrinogen levels less than 100 mg/dl. Leuk Lymphoma. Mar 1996;21(1-2):85-92. [Medline].

  51. Sebban C, Browman GP, Lepage E, Fière D. Prognostic value of early response to chemotherapy assessed by the day 15 bone marrow aspiration in adult acute lymphoblastic leukemia: a prospective analysis of 437 cases and its application for designing induction chemotherapy trials. Leuk Res. Nov 1995;19(11):861-8. [Medline].

  52. Sebban C, Lepage E, Vernant JP, et al, for the French Group of Therapy of Adult Acute Lymphoblastic Leukemia. Allogeneic bone marrow transplantation in adult acute lymphoblastic leukemia in first complete remission: a comparative study. J Clin Oncol. Dec 1994;12(12):2580-7. [Medline].

  53. Secker-Walker LM, Prentice HG, Durrant J, et al. Cytogenetics adds independent prognostic information in adults with acute lymphoblastic leukaemia on MRC trial UKALL XA. MRC Adult Leukaemia Working Party. Br J Haematol. Mar 1997;96(3):601-10. [Medline].

  54. Testi AM, Moleti ML, Giona F, et al. A single high dose of idarubicin combined with high-dose ARA-C (MSKCC ALL-3 protocol) in adult and pediatric patients with acute lymphoblastic leukemia. Experience at the University "La Sapienza" of Rome. Haematologica. Nov-Dec 1997;82(6):664-7. [Medline]. [Full Text].

  55. Thomas DA, Cortes J, O'Brien S, et al. Hyper-CVAD program in Burkitt's-type adult acute lymphoblastic leukemia. J Clin Oncol. Aug 1999;17(8):2461-70. [Medline]. [Full Text].

  56. Thomas DA, Kantarjian HM, Ravandi F, et al. Long-term Follow-up after frontline therapy with the hyper-CVAD and imatinib mesylate regimen in adults with Philadelphia (Ph) positive acute lymphocytic leukemia (ALL) [abstract]. Blood. November 2007;110:9a.

  57. Thomas X, Boiron JM, Huguet F, et al. Outcome of treatment in adults with acute lymphoblastic leukemia: analysis of the LALA-94 trial. J Clin Oncol. Oct 15 2004;22(20):4075-86. [Medline]. [Full Text].

  58. Towatari M, Yanada M, Usui N, et al, for the Japan Adult Leukemia Study Group. Combination of intensive chemotherapy and imatinib can rapidly induce high-quality complete remission for a majority of patients with newly diagnosed BCR-ABL-positive acute lymphoblastic leukemia. Blood. Dec 1 2004;104(12):3507-12. [Medline]. [Full Text].

  59. Weiss MA, Drullinsky P, Maslak P, Scheinberg D, Golde DW. A phase I trial of a single high dose of idarubicin combined with high-dose cytarabine as induction therapy in relapsed or refractory adult patients with acute lymphoblastic leukemia. Leukemia. Jun 1998;12(6):865-8. [Medline].

  60. Weiss MA, Heffner L, Lamanna N, et al. A randomized trial demonstrating the superiority of cytarabine with high-dose mitoxantrone compared to a standard vincristine/prednisone-based regimen as induction therapy for adult patients with ALL [abstract]. Presented at: Annual Meeting of the American Society of Clinical Oncology; May 13-15, 2005; Orlando, Fla. J Clin Oncol. 2005;25:6516a.

  61. Yanada M, Takeuchi J, Sugiura I, et al, for the Japan Adult Leukemia Study Group. High complete remission rate and promising outcome by combination of imatinib and chemotherapy for newly diagnosed BCR-ABL-positive acute lymphoblastic leukemia: a phase II study by the Japan Adult Leukemia Study Group. J Clin Oncol. Jan 20 2006;24(3):460-6. [Medline]. [Full Text].

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Further Reading

Related eMedicine Topics

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Keywords

acute lymphoblastic leukemia, ALL, lymphoid precursor cells, lymphoblasts, malignant lymphoid disorder, cancer, bone marrow malignancy, bone marrow cancer, leukemia, bone marrow failure, lymphoma, bone marrow carcinoma, anemia, thrombocytopenia, neutropenia, leukemia in children,

bone pain, splenomegaly, mediastinal mass, leukostasis, dizziness, palpitations, dyspnea, disseminated intravascular coagulation, DIC, pneumonia, petechiae, ecchymoses, hepatosplenomegaly, lymphadenopathy, Philadelphia chromosome, Ph chromosome, myeloproliferative disorder

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Contributor Information and Disclosures

Author

Karen Seiter, MD, Professor, Department of Internal Medicine, Division of Oncology/Hematology, New York Medical College
Karen Seiter, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, and American Society of Hematology
Disclosure: Novartis Honoraria Speaking and teaching; Schering Honoraria Speaking and teaching; Cephalon Honoraria Speaking and teaching

Medical Editor

Clarence Sarkodee-Adoo, MD, Consulting Staff, Department of Bone Marrow Transplantation, City of Hope Samaritan BMT Program
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Ronald A Sacher, MB, BCh, MD, FRCPC, Professor, Internal Medicine and Pathology, Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center
Ronald A Sacher, MB, BCh, MD, FRCPC is a member of the following medical societies: American Society of Hematology
Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Talecris Honoraria Board membership

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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