Leukemia (A Aguayo, Section Editor)

Current Oncology Reports

, Volume 14, Issue 5, pp 387-394

Philadelphia-Positive Acute Lymphoblastic Leukemia: Current Treatment Options

  • Theresa Liu-DumlaoAffiliated withThe University of Texas M.D. Anderson Cancer Center
  • , Hagop KantarjianAffiliated withThe University of Texas M.D. Anderson Cancer Center
  • , Deborah A. ThomasAffiliated withThe University of Texas M.D. Anderson Cancer Center
  • , Susan O’BrienAffiliated withThe University of Texas M.D. Anderson Cancer Center
  • , Farhad RavandiAffiliated withThe University of Texas M.D. Anderson Cancer Center Email author 

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Abstract

The Philadelphia chromosome (Ph), t(9;22), is seen in about 20 % to 30 % of adults diagnosed with acute lymphoblastic leukemia (ALL). It has been associated with poorer prognosis compared with Ph-negative ALL. Tyrosine kinase inhibitors (TKIs) targeting the BCR-ABL oncogenic protein from this translocation have been incorporated into treatment regimens used to treat patients with Ph-positive ALL. Imatinib has been the most widely used TKI with several published trials showing it produced better outcomes when combined with chemotherapy. Dasatinib, a more potent inhibitor than imatinib, has also been evaluated with promising results. However, relapses still occur at a high rate, and allogeneic stem cell transplant is considered, so far, a better curative option in first remission. Additional strategies have also included incorporation of TKIs in the post-transplant setting and the use of newer third generation TKIs. This review provides an update on emerging therapies for adults with Ph-positive ALL.

Keywords

Philadelphia chromosome ALL Tyrosine kinase inhibitors Allogeneic stem cell transplant