The cure of leukemia through the optimist's prism

Abstract

Progress is occurring at a dizzying rate across all leukemias. Since the authors' review of the topic in Cancer in 2018, numerous discoveries have been made that have improved the therapy and outcomes of several leukemia subsets. Hairy cell leukemia is potentially curable with a single course of cladribine followed by rituximab (10-year survival, ≥90%). Acute promyelocytic leukemia is curable at a rate of 80% to 90% with a nonchemotherapy regimen of all-trans retinoic acid and arsenic trioxide. The cure rate for core-binding factor acute myeloid leukemia (AML) is ≥75% with fludarabine, high-dose cytarabine, and gemtuzumab ozogamicin. Survival for patients with chronic myeloid leukemia is close to that for an age-matched normal population with BCR-ABL1 tyrosine kinase inhibitors (TKIs). Chronic lymphocytic leukemia, a previously incurable disease, may now be potentially curable with a finite duration of therapy with Bruton tyrosine kinase inhibitors and venetoclax. The estimated 5-year survival rate for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (ALL) exceeds 70% with intensive chemotherapy and ponatinib, a third-generation BCR-ABL1 TKI, and more recent nonchemotherapy regimens using dasatinib or ponatinib with blinatumomab are producing outstanding results. Survival in both younger and older patients with ALL has improved with the addition of antibodies targeting CD20, CD19 (blinatumomab), and CD22 (inotuzumab) to chemotherapy. Several recent drug discoveries (venetoclax, FLT3 and IDH inhibitors, and oral hypomethylating agents) are also improving outcomes for younger and older patients with AML and for those with higher risk myelodysplastic syndrome.

Keywords: leukemia; prognosis; progress; therapy; updates.

Figure 1.

Survival and Progression-free survival in hairy cell leukemia with cladribine followed by rituximab (MD Anderson experience). All 4 deaths unrelated to disease or treatment (1 old age 96 years; 1 suicide; 2 other cancers)

Figure 2.

Survival in chronic myeloid leukemia at MD Anderson Cancer Center over 5 decades

Figure 3.

Survival in chronic lymphocytic leukemia with ibrutinib-venetoclax

Figure 4.

Survival in younger patients with acute lymphoblastic leukemia (MD Anderson data)

Figure 5.

Survival in Philadelphia chromosome-positive acute lymphoblastic leukemia over 5 decades (MD Anderson data)