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Review
. 2018 Sep 25:8:47-61.
doi: 10.2147/BLCTT.S170351. eCollection 2018.

Recent advances in the biology and treatment of B-cell acute lymphoblastic leukemia

Mehrdad Hefazi  1 , Mark R Litzow  1
Affiliations
Review

Recent advances in the biology and treatment of B-cell acute lymphoblastic leukemia

Mehrdad Hefazi et al. Blood Lymphat Cancer. .

Abstract

Acute lymphoblastic leukemia (ALL) is a hematologic malignancy arising from precursors of the lymphoid lineage. Conventional cytotoxic chemotherapies have resulted in high cure rates of up to 90% in pediatric ALL, but the outcomes for adult patients remain suboptimal with 5-year survival rates of only 30%-40%. Over the last decade, major advances have been made in our understanding and management of ALL. Identification of new prognostic genomic markers and incorporation of minimal residual diseases' assessment into therapeutic protocols have improved risk stratification and treatment strategies. The use of pediatric-inspired regimens for adolescent and young adults, and the advent of tyrosine kinase inhibitors and novel targeted therapies, including monoclonal antibodies and chimeric antigen receptor T cells, have redefined the therapeutic paradigm of ALL, and significantly improved the outcomes. In this article, we will provide an overview of the current knowledge regarding the biology and treatment of ALL, and highlight recent diagnostic and therapeutic advances made in this area over the past 5 years.

Keywords: Philadelphia chromosome; acute lymphoblastic leukemia; hematopoietic cell transplantation; minimal residual disease; monoclonal antibodies.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Monoclonal antibodies under investigation for treatment of B-cell acute lymphoblastic leukemia. Note: List is not comprehensive. Abbreviations: ADC, antibody drug conjugate; AYA, adolescents and young adults; B-ALL, B-cell acute lymphoblastic leukemia; BFM, Berlin-Frankfurt-Munster; BiTE, bispecific T-cell engager; chemo, chemotherapy; HCVAD, hyperfractionated cyclphosphamide, vincristine, adriamycin, dexamethasone; HCT, hematopoietic cell transplantation; mAb, monoclonal antibody; Ph, Philadelphia; R/R, relapsed/refractory.
Figure 2
Figure 2
Overall survival in adults with relapsed or refractory acute lymphoblastic leukemia treated with blinatumomab vs chemotherapy (TOWER Study). Note: From the New England Journal of Medicine, Kantarjian H, Stein A, Gökbuget N, et al, Blinatumomab versus Chemotherapy for Advanced Acute Lymphoblastic Leukemia, 376(9):836–847. Copyright © (2017) Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.
Figure 3
Figure 3
Overall survival in adults with relapsed or refractory ALL treated with inotuzumab ozogamicin vs standard intensive chemotherapy (INO-VATE Trial). Note: From the New England Journal of Medicine, Kantarjian HM, Deangelo DJ, Stelljes M, et al, Inotuzumab Ozogamicin versus Standard Therapy for Acute Lymphoblastic Leukemia, 375(8):740–753. Copyright © (2016) Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.
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