Advances in the management of acute lymphoblastic leukemia

This article aimed to review the advances in the treatment of acute lymphoblastic leukemia in adults. 

This article concluded that the development of improved treatments has led to better outcomes for these patients.  

Acute lymphoblastic leukemia (ALL) is an aggressive cancer of blood-forming cells. Chemotherapy has improved over the years and has improved the outcomes in pediatric patients. However, in older patients, the outcomes are poorer. Therefore, it is important to permanently research newer medications for these patients.

Rituximab (Rituxan) is a monoclonal antibody (targeted therapy). Adding rituximab to standard chemotherapy improves survival in the frontline treatment of B cell ALL. Measurable residual disease (MRD) is the most important prognostic factor. MRD is when a small number of cancer cells remain after treatment. A prognostic factor can be used to estimate the chance of recovery from a disease or the chance of relapse.  

Tyrosine kinase inhibitors (TKI) are a type of targeted therapy. Adding ponatinib (Iclusig) to Hyper-CVAD (chemotherapy regime including cyclophosphamide, vincristine, doxorubicin, and dexamethasone) significantly improved the outcomes in Philadelphia-positive ALL. 

Blinatumomab (Blincyto), inotuzumab ozogamicin (Besponsa), and chimeric antigen receptor (CAR) T cells are better options than chemotherapy alone for relapsed or unresponsive ALL. A combination of these treatments with chemotherapy and their incorporation in the frontline setting could improve cure rates of ALL. 

This article concluded that the development of monoclonal antibodies, CAR-T and potent TKI drugs has improved outcomes for ALL. Advances in the understanding of ALL will enable new treatment strategies in the future.