Treatment of Philadelphia-chromosome-positive acute lymphoblastic leukemia with imatinib in combination with chemotherapy

A comprehensive study for selecting optimal treatment modalities for blood cancer in a Fermatean fuzzy dynamic environment

Cancer is characterized by uncontrolled cell proliferation, leading to cellular damage or death. Acute lymphoblastic leukemia (ALL), a kind of blood cancer, that affects lymphoid cells and is a challenging malignancy to treat. The Fermatean fuzzy set (FFS) theory is highly effective at capturing imprecision due to its capacity to incorporate extensive problem descriptions that are unclear and periodic. Within the framework of this study, two innovative aggregation operators: The Fermatean fuzzy Dynamic Weighted Averaging (FFDWA) operator and the Fermatean fuzzy Dynamic Weighted Geometric (FFDWG) operator are presented. The important attributes of these operators, providing a comprehensive elucidation of their significant special cases has been discussed in details. Moreover, these operators are utilized in the development of a systematic approach for addressing scenarios involving multiple attribute decision-making (MADM) problems with Fermatean fuzzy (FF) data. A numerical example concerning on finding the optimal treatment approach for ALL using the proposed operators, is provided. At the end, the validity and merits of the new method to illustrate by comparing it with the existing methods.

Use of CAR T-cell for acute lymphoblastic leukemia (ALL) treatment: a review study

Acute lymphoblastic leukemia (ALL) is a cancer-specific lymphoid cell. Induction and consolidation chemotherapy alone or in combination with different therapeutic approaches remain the main treatment. Although complete or partial remission of the disease can be achieved, the risk of relapse or refractory leukemia is still high. More effective and safe therapy options are yet unmet needs. In recent years' new therapeutic approaches have been widely used. Hematopoietic Stem Cell Transplantation (HSCT) presents significant limitations and the outcome of the consolidation treatment is patient dependent. Side effects such as Graft versus Host Disease (GvHD) in allogeneic hematopoietic stem cell transplantation are extremely common, therefore, using alternative methods to address these challenges for treatment seems crucial. In the last decade, T cells genetically engineered with Chimeric Antigen Receptor (CAR) treatment for the ALL are largely studied and represent the new era of strategy. According to the Phase I/II clinical trials, this technology results seem very promising and can be used in the next future as an effective and safe treatment for ALL treatment. In this review different generations, challenges, and clinical studies related to chimeric antigen receptor (CAR) T-cells for ALL treatment are discussed.

Changing paradigm of the treatment of Philadelphia chromosome-positive acute lymphoblastic leukemia

In the pre-imatinib era, the treatment outcome of patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph(+) ALL) was dismal. Complete remission was generally achieved only in about 50% to 60% of patients, and allogeneic hematopoietic stem cell transplantation (allo-HSCT), when feasible in younger patients, was virtually the sole curative modality. Imatinib has changed the situation dramatically, however, in combination with conventional chemotherapy or with corticosteroid alone, producing about 95% complete remission and thus increasing the number of patients undergoing allo-HSCT. Currently, the overall survival of patients who have undergone allo-HSCT exceeds 50%, and a considerable proportion of patients for whom allo-HSCT is not feasible are predictably curable. The next question is how to prevent relapse, which is observed not only in more than half of patients for whom allo-HSCT is not feasible but also in a considerable number of patients after allo-HSCT. Thus, improvement of postremission therapy is crucial. Whether intensive chemotherapy with currently available cytotoxic drugs contributes to the prevention of relapse is questionable, because intensive chemotherapy alone in the pre-imatinib era nearly always failed to cure this disease. Promising partners to be combined with imatinib or with a second-generation tyrosine kinase inhibitor (TKI) will be corticosteroids and vincristine. New TKIs such as dasatinib should be incorporated into the early phase of postremission therapy. Recognizing the small number of patients with Ph(+) ALL, intergroup or international studies are necessary to develop the best postremission therapy. In the near future, it is hoped that Ph(+) ALL will become one of the leukemias for which allo-HSCT is offered only for relapsed or extremely high-risk patients.