Targeted Therapy in the Treatment of Pediatric Acute Lymphoblastic Leukemia-Therapy and Toxicity Mechanisms

Abstract

Targeted therapy has revolutionized the treatment of poor-prognosis pediatric acute lymphoblastic leukemia (ALL) with specific genetic abnormalities. It is still being described as a new landmark therapeutic approach. The main purpose of the use of molecularly targeted drugs and immunotherapy in the treatment of ALL is to improve the treatment outcomes and reduce the doses of conventional chemotherapy, while maintaining the effectiveness of the therapy. Despite promising treatment results, there is limited clinical research on the effect of target cell therapy on the potential toxic events in children and adolescents. The recent development of highly specific molecular methods has led to an improvement in the identification of numerous unique expression profiles of acute lymphoblastic leukemia. The detection of specific genetic mutations determines patients' risk groups, which allows for patient stratification and for an adjustment of the directed and personalized target therapies that are focused on particular molecular alteration. This review summarizes the knowledge concerning the toxicity of molecular-targeted drugs and immunotherapies applied in childhood ALL.

Keywords: acute lymphoblastic leukemia; immunotherapy; molecular toxicity; pediatric; side effects; target therapy; tyrosine kinase inhibitors.

Figure 1

Toxicities associated with targeted therapy in pediatric patients with ALL. TKI—tyrosine kinase inhibitor; TNF—tumor necrosis factor; TAA—tumor-associated antigen; CNS—central nervous system; ALT—alanine transaminase; AST—aspartate transaminase, SOS—sinusoidal obstruction syndrome.