Treating adults with acute lymphocytic leukemia: new pharmacotherapy options

ABSTRACT

Introduction: Advances in acute lymphocytic leukemia (ALL) therapy has led to long-term survival rates in children. However, only 30%-40% of adults achieve long-term disease-free survival. After relapse, the outcome of salvage chemotherapy is very disappointing with less than 10% of long survival. Novel agents are therefore desperately required to improve response rates and survival, but also the quality of life of patients.

Areas covered: The following review is a comprehensive summary of various novel options reported over the past few years in the therapeutic area of adult ALL.

Expert opinion: Identifying key components involved in disease pathogenesis may lead to new approaches. In a near future, the incorporation of monoclonal antibodies and T-cell directed approaches including blinatumomab and chimeric antigen receptor T cells may increase the cure rates and may reduce the need for intensive therapy.

KEYWORDS:

• Acute lymphoblastic leukemia
• treatment
• targeted therapy
• monoclonal antibodies
• prognosis

Article highlights

• Despite recent improvements, most adults with newly diagnosed acute lymphocytic leukemia (ALL) will experience relapse. This emphasizes the urgent need to develop better therapies in this patient population.

• New drugs have recently emerged including new nucleoside analogs, new formulations of existing chemotherapeutic agents, new antimetabolites, monoclonal antibodies and immunotherapy, and targeted molecular therapies.

• Monoclonal antibodies targeting surface markers such as CD20, CD19, or CD22 represent one of the most exiting groups of compounds currently under investigations.

• In Philadelphia chromosome-positive ALL, the best results are currently shown with tyrosine kinase inhibitors incorporated early, daily, and continuously with chemotherapy.

• Progress in the identification of genomic-defined sub-entities, the development of new technologies, a better evaluation of minimal residual disease, and the development of new targeted therapies tend to led to a substantial realization of personalized treatment in this disease.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.