Evolving therapy of adult acute lymphoblastic leukemia: state-of-the-art treatment and future directions

Abstract

Recent years have witnessed major advances that have improved outcome of adults with acute lymphoblastic leukemia (ALL). The emergence of the concept of measurable residual disease has fine-tuned our prognostic models and guided our treatment decisions. The treatment paradigms of ALL have been revolutionized with the advent of tyrosine kinase inhibitors targeting BCR-ABL1, monoclonal antibodies targeting CD20 (rituximab), antibody-drug conjugates targeting CD22 (inotuzumab ozogamicin), bispecific antibodies (blinatumomab), and CD19 chimeric antigen receptor T cell therapy (tisagenlecleucel). These highly effective new agents are allowing for novel approaches that reduce reliance on intensive cytotoxic chemotherapy and hematopoietic stem cell transplantation in first remission. This comprehensive review will focus on the recent advances and future directions in novel therapeutic strategies in adult ALL.

Keywords: Acute lymphoblastic leukemia; Blinatumomab; Chimeric antigen receptor; Inotuzumab ozogamicin; Monoclonal antibody.

Fig. 1

Proposed treatment algorithm of adult ALL according to MRD status. ALL, acute lymphoblastic leukemia; MRD, measurable residual disease; Ph, Philadelphia-chromosome; HSCT, hematopoietic stem cell transplant; CMR, complete molecular response; TKI, tyrosine kinase inhibitor; ETP, early T cell precursor