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Recent Advances in Adult Acute Lymphoblastic Leukemia

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Abstract

Purpose of Review

This article reviews the recent advances in the pathophysiology and management of acute lymphoblastic leukemia (ALL) in adults.

Recent Findings

Addition of rituximab to standard chemotherapy improves survival in the frontline treatment of B cell ALL, and measurable residual disease (MRD) is the most important prognostic factor. Tyrosine kinase inhibitors (TKI), particularly ponatinib, in combination with Hyper-CVAD significantly improve outcomes in Ph + ALL challenging the benefit of allogeneic stem cell transplant in first line for these patients. Blinatumomab, inotuzumab ozogamicin, and chimeric antigen receptor (CAR) T cells are better options than chemotherapy alone for the treatment of relapsed or refractory ALL. Combination of these agents with chemotherapy and their incorporation in the frontline setting show promises to improve cure rates of ALL.

Summary

Development of monoclonal antibodies, CAR T, and potent TKI has improved the outcome of ALL. Advances in our understanding of ALL biology are expected to bring new therapeutic strategies in the upcoming years.

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  1. Department of Leukemia, University of Texas, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Box 428, Houston, TX, 77030, USA

    Guillaume Richard-Carpentier, Hagop Kantarjian & Elias Jabbour

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  1. Guillaume Richard-Carpentier
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Guillaume Richard-Carpentier reports grants from Cole Foundation, outside the submitted work. Hagop Kantarjian reports grants from Abb Vie, grants from Agios, grants from Amgen, grants from Ariad, grants from Astex, grants from BMS, grants from Cyclacel, grants from Daiichi-Sankyo, grants from Immunogen, grants from Jazz Pharma, grants from Novartis, grants from Pfizer, other from AbbVie, other from Actinium (Advisory Board), other from Agios, other from Amgen, other from Immunogen, other from Orsinex, other from Pfizer, and other from Takeda, during the conduct of the study. Elias Jabbour reports grants and personal fees from Takeda, grants and personal fees from Pfizer, grants and personal fees from Amgen, grants and personal fees from Abbvie, grants and personal fees from Spectrum, grants from Novartis, and from Bristol-Myers Squibb, during the conduct of the study.

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Richard-Carpentier, G., Kantarjian, H. & Jabbour, E. Recent Advances in Adult Acute Lymphoblastic Leukemia. Curr Hematol Malig Rep 14, 106–118 (2019). https://doi.org/10.1007/s11899-019-00503-1

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