Therapeutic developments in acute lymphoblastic leukemia

Abstract

Amy MacKenzie, Margaret KasnerDepartment of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USAAbstract: The standard treatment of adult-onset acute lymphoblastic leukemia (ALL) is based on trials conducted 20–25 years ago and has remained largely unchanged since that time. Treatments are lengthy and have been extrapolated from successful pediatric regimens. However, adult disease is cytogenetically different from pediatric disease. Adults often have comorbidities that make completing treatment challenging, and outcomes subsequently suffer. Advances in the understanding of cytogenetics and molecular biology have led to the identification of prognostic factors, as well as offering fertile ground for the development of new therapeutics. The current research in ALL focuses on the development of monoclonal antibodies and small molecule inhibitors, as well as increasing sensitivity in monitoring minimal residual disease, improving upon current chemotherapy, and improving stem cell transplantation. This monograph reviews the current standard of care for adult ALL and the innovations in clinical investigation that aim to improve the future for adults who suffer from this disease. The adult population is in great need of similar advances and stands to benefit tremendously from the research discussed in this review. The challenges of sustainable remission and reduced morbidity and mortality in treatment remain to be surmounted. The aggressive efforts of current clinical trials that are investigating novel therapies both alone and with standard treatment offer hope for adults that is slowly beginning to be realized.Keywords: adult acute lymphoblastic leukemia, Philadelphia chromosome, monoclonal antibodies, molecular pathways