for dasatinib, a tyrosine kinase inhibitor. it has shown efficacy in cases of people with ph1-positive and imatinib-resistant all, but more research needs to be done on long-term survival and time to relapse. side effects chemotherapies or stem cell transplantations may require a platelet transfusion to prevent bleeding. moreover, patients undergoing a stem cell transplantation can develop a graft-versus-host disease (gvhd). it was evaluated whether mesenchymal stromal cells can be used to prevent a gvhd. the evidence is very uncertain about the therapeutic effect of mesenchymal stromal cells to treat graft-versus-host diseases after a stem cell transplantation on the all-cause mortality and complete disappear of chronic acute graft-versus-host diseases. mesenchymal stromal cells may results in little to no difference in the all-cause mortality, relapse of malignant disease and incidence of acute and chronic graft-versus-host diseases if they are used for prophylactic reason. supportive therapy adding physical exercises to the standard treatment for adult patients with haematological malignancies like all may result in little to no difference in mortality, quality of life, and physical functioning. these exercises may result in a slight reduction in depression. furthermore, aerobic physical exercises probably reduce fatigue. the evidence is very uncertain about the effect on anxiety and serious adverse events. gene therapy brexucabtagene autoleucel (tecartus) was approved for the treatment of adults with relapsed or refractory b-cell precursor acute lymphoblastic leukemia in october 2021. each dose of brexucabtagene autoleucel is a customized treatment created using the recipient's own immune system to help fight the lymphoma. the recipient's t cells, a type of white blood cell, are collected and genetically modified to include a new gene that facilitates the targeting and killing of the lymphoma cells. these modified t cells are then infused back into the recipient. prognosis prior to the development of chemotherapy regimens and hematopoietic stem cell transplant, children were surviving a median length of 3 months, largely due to either infection or bleeding. since the advent of chemotherapy, the prognosis for childhood leukemia has improved greatly and children with all are estimated to have a 95% probability of achieving a successful remission after 4 weeks of initiating treatment. people in pediatric care with all in developed countries have a greater than 80% five-year survival rate. it is estimated that 60–80% of adults undergoing induction chemotherapy achieve complete remission after 4 weeks, and those over the age of 70 have a cure rate of 5%. graphs of overall survival rates at 5 years and 10 years in people in pediatric care and adults with all however, there are differing prognoses for all among individuals depending on a variety of factors: gender: females tend to fare better than males. ethnicity: caucasians are more likely to develop acute leukemia than african-americans, asians, or hispanics. however, they also tend to have a better prognosis than non-caucasians. age at diagnosis: children 1–10 years of age are most likely to develop all and to be cured of it. cases in older people are more likely to result from chromosomal abnormalities (e.g., the philadelphia chromosome) that make treatment more difficult and prognoses poorer. older people are also likely to have co-morbid medical conditions that make it even more difficult to tolerate all treatment. white blood cell count at diagnosis of greater than 30,000 (b-all) or 100,000 (t-all) is associated with worse outcomes cancer spreading into the central nervous system (brain or spinal cord) has worse outcomes. morphological, immunological, and genetic subtypes person's response to initial treatment and longer length of time required (greater than 4 weeks) to reach complete remission early relapse of all minimal residual disease genetic disorders, such as down syndrome, and other chromosomal abnormalities (aneuploidy and translocations) in children factorunfavorablefavorable age<2 or >10 years3–5 years sexmalefemale raceblackcaucasian organomegalypresentabsent mediastinal masspresentabsent cns involvementpresentabsent leukocyte countb-all >30,000mm3 t-all >100,000mm3 low hemogblobin concentration>10g/dl<10g/dl cell typenon lymphoidlymphoid cell lineagepre b cell + t-all (children) early pre b cell karyotypetranslocationhyperdiploidy response to treatmentslow >1 week to clear blasts from blood rapid <1 week to clear blasts from blood time to remission >4 weeks <4 weeks minimal residual disease positive at 3 – 6 months negative at 1 month (children) or 3 months (adults) cytogenetics, the study of characteristic large changes in the chromosomes of cancer cells, is an important predictor of outcome. some cytogenetic subtypes have a worse prognosis than others. these include: person with t(9,22) positive-all (30% of adult all cases) and other bcr-abl-rearranged leukemias are more likely to have a poor prognosis, but survival rates may rise with treatment consisting of chemotherapy and bcr-abl tyrosine kinase inhibitors. a translocation between chromosomes 4 and 11 occurs in about 4% of cases and is most common in infants under 12 months. cytogenetic change risk category philadelphia chromosome poor prognosis t(4;11)(q21;q23) poor prognosis t(8;14)(q24.1;q32) poor prognosis complex karyotype (more than four abnormalities) poor prognosis low hypodiploidy or near triploidy poor prognosis deletion of chromosome 7 poor prognosis trisomy 8 poor prognosis high hyperdiploidy (trisomy 4, 10, 17) good prognosis del(9p) good prognosis hyperdiploidy (>50 chromosomes) and t(12;21) are good prognostic factors and also makeup 50% of pediatric all cases. based on bone marrow cytogenetics prognosis cytogenetic findings favorable hyperdiploidy > 50 ; t (12;21) intermediate hyperdiploidy 47–50; normal(diploidy); del (6q); rearrangements of 8q24 unfavorable hypodiploidy-near haploidy; near tetraploidy; del (17p); t (9;22); t (11q23) unclassified all is considered to have an intermediate prognosis risk, somewhere in-between the good and poor risk categories. epidemiology all affected about 876,000 people and resulted in 111,000 deaths globally in 2015. it occurs in both children and adults with highest rates seen between the ages three and seven years. around 75% of cases occur before the age of 6 with a secondary rise after the age of 40. it is estimated to affect 1 in 1500 children. accounting for the broad age profiles of those affected, all newly occurs in about 1.7 per 100,000 people per year. all represents approximately 20% of adults and 80% of childhood leukemias, making it the most common childhood cancer. although 80 to 90% of children will have a long term complete response with treatment,: 1527 it remains the leading cause of cancer-related deaths among children. 85% of cases are of b-cell lineage and have an equal number of cases in both males and females. the remaining 15% of t-cell lineage have a male predominance. globally, all typically occurs more often in caucasians, hispanics, and latin americans than in africans.: 1617 in the us, all is more common in children from caucasian (36 cases/million) and hispanic (41 cases/million) descent when compared to those from african (15 cases/million) descent. pregnancy leukemia is rarely associated with pregnancy, affecting only about 1 in 10,000 pregnant women. the management of leukemia in a pregnant woman depends primarily on the type of leukemia. acute leukemias normally require prompt, aggressive treatment, despite significant risks of pregnancy loss and birth defects, especially if chemotherapy is given during the developmentally sensitive first trimester.