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Soverini S, Albano F, Bassan R, Fabbiano F, Ferrara F, Foà R, Olivieri A, Rambaldi A, Rossi G, Sica S, Specchia G, Venditti A, Barosi G, Pane F. Next-generation sequencing for BCR-ABL1 kinase domain mutations in adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia: A position paper. Cancer Med 2020; 9:2960-2970. [PMID: 32154668 PMCID: PMC7196068 DOI: 10.1002/cam4.2946] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/15/2020] [Accepted: 02/12/2020] [Indexed: 12/28/2022] Open
Abstract
Emergence of clones carrying point mutations in the BCR‐ABL1 kinase domain (KD) is a common mechanism of resistance to tyrosine kinase inhibitor (TKI)‐based therapies in Philadelphia chromosome‐positive (Ph+) acute lymphoblastic leukemia (ALL). Sanger sequencing (SS) is the most frequently used method for diagnostic BCR‐ABL1 KD mutation screening, but it has some limitations—it is poorly sensitive and cannot robustly identify compound mutations. Next‐generation sequencing (NGS) may overcome these problems. NSG is increasingly available and has the potential to become the method of choice for diagnostic BCR‐ABL1 KD mutation screening. A group discussion within an ad hoc constituted Panel of Experts has produced a series of consensus‐based statements on the potential value of NGS testing before and during first‐line TKI‐based treatment, in relapsed/refractory cases, before and after allo‐stem cell transplantation, and on how NGS results may impact on therapeutic decisions. A set of minimal technical and methodological requirements for the analysis and the reporting of results has also been defined. The proposals herein reported may be used to guide the practical use of NGS for BCR‐ABL1 KD mutation testing in Ph+ ALL.
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Affiliation(s)
- Simona Soverini
- Institute of Hematology "Lorenzo e Ariosto Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Francesco Albano
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari, Bari, Italy
| | - Renato Bassan
- Ospedale dell'Angelo, UOC Ematologia, Mestre-Venezia, Italy
| | | | | | - Robin Foà
- Division of Hematology University "Sapienza", Rome, Italy
| | - Attilio Olivieri
- Department of Hematology, Università Politecnica delle Marche, Ancona, Italy
| | - Alessandro Rambaldi
- Department of Oncology and Hemato-Oncology, University of Milan and Azienda Socio-Sanitaria Territoriale (ASST) Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Rossi
- Dipartimento di Oncologia Clinica, A.O. Spedali Civili, Brescia, Italy
| | - Simona Sica
- Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgina Specchia
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari, Bari, Italy
| | - Adriano Venditti
- Dipartimento di Biomedicina e Prevenzione, Universitá Tor Vergata, Rome, Italy
| | | | - Fabrizio Pane
- U.O.C. Ematologia e Trapianti di Midollo Azienda Ospedaliera, Universitaria Federico II di Napoli, Naples, Italy
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DeFilipp Z, Advani AS, Bachanova V, Cassaday RD, Deangelo DJ, Kebriaei P, Rowe JM, Seftel MD, Stock W, Tallman MS, Fanning S, Inamoto Y, Kansagra A, Johnston L, Nagler A, Sauter CS, Savani BN, Perales MA, Carpenter PA, Larson RA, Weisdorf D. Hematopoietic Cell Transplantation in the Treatment of Adult Acute Lymphoblastic Leukemia: Updated 2019 Evidence-Based Review from the American Society for Transplantation and Cellular Therapy. Biol Blood Marrow Transplant 2019; 25:2113-2123. [PMID: 31446198 DOI: 10.1016/j.bbmt.2019.08.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 01/05/2023]
Abstract
The role of hematopoietic cell transplantation (HCT) in adults with acute lymphoblastic leukemia (ALL) is reviewed and critically evaluated in this systematic evidence-based review. Specific criteria were used for searching the published literature and for grading the quality and strength of the evidence and the strength of the recommendations. A panel of ALL experts developed consensus on the treatment recommendations based on the evidence. Allogeneic HCT offers a survival benefit in selected patients with ALL, and this review summarizes the standard indications as well as the areas of controversy. There is now greater experience with pediatric-inspired chemotherapy regimens that has transformed upfront therapy for adult ALL, resulting in higher remission rates and overall survival. This in turn has increased the equipoise around decision making for ALL in first complete remission (CR1) when there is no measurable residual disease (MRD) at the end of induction and/or consolidation. Randomized studies are needed for adults with ALL to compare allogeneic HCT in CR1 with pediatric-inspired chemotherapy alone. Indications for transplantation in the evolving landscape of MRD assessments and novel targeted and immune therapeutics remain important areas of investigation.
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Affiliation(s)
- Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA.
| | - Anjali S Advani
- Department of Medical Oncology & Hematology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Veronika Bachanova
- Division of Hematology/Oncology/Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN
| | - Ryan D Cassaday
- Division of Clinical Research, Fred Hutchinson Cancer Research Center and Department of Medicine, University of Washington, Seattle, WA, USA
| | - Daniel J Deangelo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jacob M Rowe
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Wendy Stock
- Department of Hematology and Oncology, Comprehensive Cancer Center, University of Chicago, Chicago, IL
| | - Martin S Tallman
- Leukemia Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Suzanne Fanning
- Hematology and Medical Oncology, Greenville Health System Cancer Institute, Greenville, SC
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Ankit Kansagra
- Department of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Laura Johnston
- Department of Medicine, Stanford University Medical Center, Stanford, CA
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Craig S Sauter
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Paul A Carpenter
- Division of Clinical Research, Fred Hutchinson Cancer Research Center and Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Richard A Larson
- Department of Hematology and Oncology, Comprehensive Cancer Center, University of Chicago, Chicago, IL
| | - Daniel Weisdorf
- Division of Hematology/Oncology/Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN
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Chen YB, McCarthy PL, Hahn T, Holstein SA, Ueda M, Kröger N, Bishop M, de Lima M. Methods to prevent and treat relapse after hematopoietic stem cell transplantation with tyrosine kinase inhibitors, immunomodulating drugs, deacetylase inhibitors, and hypomethylating agents. Bone Marrow Transplant 2018; 54:497-507. [DOI: 10.1038/s41409-018-0269-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 11/09/2022]
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5
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Tyrosine kinase inhibitors and immune checkpoint blockade in allogeneic hematopoietic cell transplantation. Blood 2018; 131:1073-1080. [PMID: 29358177 DOI: 10.1182/blood-2017-10-752154] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 01/16/2018] [Indexed: 12/27/2022] Open
Abstract
Advances in the prevention of graft-versus-host disease (GVHD) and opportunistic infection have improved survival after allogeneic hematopoietic cell transplantation (allo-HCT) in the past decade. However, few inroads have been made into the treatment or prevention of relapse of the underlying malignancy for which allo-HCT is being performed. The introduction of US Food and Drug Administration-approved agents with significant activity in a variety of hematologic malignancies provides an opportunity to evaluate these interventions in the allo-HCT setting. Some of the most promising new agents include tyrosine kinase inhibitors (TKIs) directed at bcr-abl, kinase inhibitors targeting fms-like tyrosine kinase 3, and immune checkpoint inhibitors blocking both CTLA4 and PD-1. Data have emerged indicating potential efficacy of these agents in preventing or treating relapse, though definitive evidence remains elusive. However, potential toxicity can be considerable, highlighting the need for further clinical trials to define the therapeutic window. This review explores the immunologic and clinical consequence of treatment with both TKIs and checkpoint inhibitors in the peri- and post-allo-HCT setting.
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Soiffer RJ, Chen YB. Pharmacologic agents to prevent and treat relapse after allogeneic hematopoietic cell transplantation. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:699-707. [PMID: 29222324 PMCID: PMC6142540 DOI: 10.1182/asheducation-2017.1.699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Robert J. Soiffer
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA; and
| | - Yi-Bin Chen
- Harvard Medical School, Boston, MA; and
- Massachusetts General Hospital, Boston, MA
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Pharmacologic agents to prevent and treat relapse after allogeneic hematopoietic cell transplantation. Blood Adv 2017; 1:2473-2482. [PMID: 29296897 DOI: 10.1182/bloodadvances.2017009894] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/28/2017] [Indexed: 01/01/2023] Open
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Strategies and Challenges for Pharmacological Maintenance Therapies after Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2016; 22:2134-2140. [DOI: 10.1016/j.bbmt.2016.08.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/12/2016] [Indexed: 11/19/2022]
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Giebel S, Czyz A, Ottmann O, Baron F, Brissot E, Ciceri F, Cornelissen JJ, Esteve J, Gorin NC, Savani B, Schmid C, Mohty M, Nagler A. Use of tyrosine kinase inhibitors to prevent relapse after allogeneic hematopoietic stem cell transplantation for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia: A position statement of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Cancer 2016; 122:2941-51. [PMID: 27309127 DOI: 10.1002/cncr.30130] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/13/2016] [Accepted: 04/19/2016] [Indexed: 01/18/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (alloHSCT) is a standard of care for patients with Philadelphia chromosome (Ph)-positive acute lymphoblastic leukemia (ALL). The introduction of tyrosine kinase inhibitors (TKIs) to first-line therapy has improved overall outcomes; however, a significant proportion of patients still relapse after alloHSCT. Posttransplant TKI maintenance was demonstrated to reduce the risk of relapse in a large retrospective study and, therefore, should be considered a valuable option. This consensus paper, written on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation, presents an overview of clinical studies on the use of TKIs after alloHSCT and proposes practical recommendations regarding the choice of TKI, treatment timing, and dosage. It is hoped that these recommendations will become the state of art in this field and, more importantly, lead to a reduction of Ph-positive ALL relapse after alloHSCT. Cancer 2016;122:2941-2951. © 2016 American Cancer Society.
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Affiliation(s)
- Sebastian Giebel
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland.
| | - Anna Czyz
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Oliver Ottmann
- Institute of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Frederic Baron
- Department of Hematology, Centre Hospitalier Universitaire Sart-Tilman, University of Liege, Belgium, France
| | - Eolia Brissot
- Clinical Hematology and Cellular Therapy Department, Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation (BMT) Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Jan J Cornelissen
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Jordi Esteve
- Hematology Department, August Pi i Sunyer Institute for Biomedical Research, Hospital Clinic, Barcelona, Spain
| | - Norbert-Claude Gorin
- Clinical Hematology and Cellular Therapy Department, Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bipin Savani
- Department of Hematology and Transplantation, Vanderbilt University, Nashville, Tennessee
| | - Christoph Schmid
- Department of Hematology and Oncology, Klinikum Augsburg, Ludwig-Maximilians-Universitaet, Munich, Augsburg, Germany
| | - Mohamad Mohty
- Clinical Hematology and Cellular Therapy Department, Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,European Society for Blood and Marrow Transplantation Acute Leukemia Working Party Office, Hospital Saint-Antoine, Paris, France
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Huguet F. Dasatinib for acute lymphoblastic leukemia. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1098530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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11
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Effects of conditioning intensity in allogeneic stem cell transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia. Int J Hematol 2015; 102:689-96. [DOI: 10.1007/s12185-015-1883-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 09/04/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
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12
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Ito Y, Miyamoto T, Kamimura T, Aoki K, Henzan H, Aoki T, Shiratsuchi M, Kato K, Nagafuji K, Ogawa R, Eto T, Iwasaki H, Akashi K. Characteristics of Patients With Development of Large Granular Lymphocyte Expansion Among Dasatinib-Treated Patients With Relapsed Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia After Allogeneic Stem Cell Transplantation. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:e47-54. [DOI: 10.1016/j.clml.2014.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/06/2014] [Accepted: 09/17/2014] [Indexed: 11/28/2022]
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Kondo T, Tasaka T, Matsumoto K, Matsumoto R, Koresawa L, Sano F, Tokunaga H, Matsuhashi Y, Nakanishi H, Morita K, Wada H, Sugihara T. Philadelphia chromosome-positive acute lymphoblastic leukemia with extramedullary and meningeal relapse after allogeneic hematopoietic stem cell transplantation that was successfully treated with dasatinib. SPRINGERPLUS 2014; 3:177. [PMID: 24790822 PMCID: PMC4000600 DOI: 10.1186/2193-1801-3-177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/17/2014] [Indexed: 01/22/2023]
Abstract
Central nervous system (CNS) relapse is a critical issue while treating Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph-positive ALL). A 58-year-old woman with Ph-positive ALL who relapsed after bone marrow transplantation for meningeal leukemia was treated with high-dose methotrexate, which resulted in remission. She underwent allogeneic cord blood transplantation followed by reduced intensity conditioning chemotherapy with imatinib; however, she experienced CNS relapse and developed an extramedullary mass on the right side of the temporal region. We treated 40 mg of dasatinib once daily, which had to be temporarily discontinued because she developed grade 2 pleural effusion and grade 2 hematemesis. After reinitiation of dasatinib, the extramedullary mass disappeared and meningeal leukemia ameliorated almost immediately. With 40 mg dasatinib administered once daily, its trough level and cerebrospinal fluid (CSF) concentration were 32 ng/mL and below the sensitivity threshold of 1 ng/mL, respectively. Treatment was continued, and the patient remained in complete remission until she died of pneumonia 7 years after the initial diagnosis of ALL. Dasatinib can be an effective treatment for Ph-positive ALL with CNS relapse. Although the concentration in the CSF seems low, it may be sufficient to exert anti-leukemic effects in the human CNS.
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Affiliation(s)
- Toshinori Kondo
- Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan
| | - Taizo Tasaka
- Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan
| | - Kana Matsumoto
- Department of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts, Kodo, Kyotanabe, Kyoto, 610-0395 Japan
| | - Rui Matsumoto
- Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan
| | - Lisa Koresawa
- Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan
| | - Fuminori Sano
- Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan
| | - Hirotoshi Tokunaga
- Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan
| | - Yoshiko Matsuhashi
- Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan
| | - Hidekazu Nakanishi
- Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan
| | - Kunihiko Morita
- Department of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts, Kodo, Kyotanabe, Kyoto, 610-0395 Japan
| | - Hideho Wada
- Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan
| | - Takashi Sugihara
- Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan
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Clinical outcome of hematopoietic stem cell transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph + ALL): experience from a single institution. Pathol Oncol Res 2013; 20:61-6. [PMID: 23821455 DOI: 10.1007/s12253-013-9658-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
Abstract
To identify factors affecting transplant outcome, data from 65 Philadelphia Chromosome-positive acute lymphoblastic leukemia (Ph + ALL) patients who had undergone allogeneic hematopoietic transplantation (allo-HSCT) in our institution were analyzed. The probability of OS (overall survival) and DFS (disease free-survival) at 3 years after allo-HSCT was 40.1% and 38%, respectively. Multivariate analysis showed that gender and disease status (p = 0.0059, p = 0.0039, respectively) were significant factors for OS. Among 51 patients with CR (complete remission), multivariate analysis showed that the factors associated with OS included gender (p = 0.014), number of white blood cell at diagnosis (p = 0.025), and the source of stem cells (bone marrow <BM > versus cord blood; BM stem cell source was associated with favorable OS, p = 0.042). Twenty-one patients relapsed after allo-HSCT with a median of 207 days (range, 19-1,324 days). The estimated cumulative incidence of relapse at 3 years was 39.4%. Patients with CR showed a lower relapse rate at 3 years (34.2%) when compared with patients with non-CR (62.7%). Among 21 patients, eight patients received imatinib-based chemotherapy and 13 received chemotherapy without imatinib before HSCT. In terms of treatment after relapse, seven patients received chemotherapy with imatinib and 13 received chemotherapy without imatinib. Five patients underwent a second HSCT. One patient survived, and 20 patients died. In this study, disease status at time of allo-HSCT had a significant impact on OS, DFS, and relapse. Imatinib administration given before allo-HSCT was not associated with favorable outcome. Second-generation tyrosine kinase inhibitors may be more suitable candidates for Ph + ALL before and after allo-HSCT.
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Zhao Y, Huang H, Wei G. Novel agents and biomarkers for acute lymphoid leukemia. J Hematol Oncol 2013; 6:40. [PMID: 23773228 PMCID: PMC3718656 DOI: 10.1186/1756-8722-6-40] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 05/23/2013] [Indexed: 12/16/2022] Open
Abstract
New genetic markers for adult acute lymphoblastic leukemia (ALL) have been found to have prognostic impact, such as the lymphoid transcription factor gene IKZF1 alterations, which are associated with a high rate of leukemic relapse in B-ALL. Although complete remission rates by induction chemotherapy in ALL are now high, the long-term survival is still disappointing. Improvements in the survival outcome of ALL have been observed in young adults as a result of the use of pediatric inspired regimens and the broadening of the number of patients who are eligible for allogeneic SCT. Development of new and less toxic agents also provide promise to improve the outcome in adult ALL, such as tyrosine kinase inhibitors in Ph-positive ALL, rituximab in CD20-positive disease, blinatumomab in precursor B-ALL and nelarabine in T-lineage ALL. Challenges for the future are to implement genomic profiling into the clinical setting to guide risk stratification and providing novel targets for tailored therapies.
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Affiliation(s)
- Yanmin Zhao
- Bone Marrow Transplantation Center, The First Affiliated Hospital of Zhejiang University, No. 79 Qing Chun Rd, Hangzhou 310003, China
| | - He Huang
- Bone Marrow Transplantation Center, The First Affiliated Hospital of Zhejiang University, No. 79 Qing Chun Rd, Hangzhou 310003, China
| | - Guoqing Wei
- Bone Marrow Transplantation Center, The First Affiliated Hospital of Zhejiang University, No. 79 Qing Chun Rd, Hangzhou 310003, China
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