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Treatment of Acute Lymphoblastic Leukaemia

A New Era

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Abstract

Acute lymphocytic leukaemia (ALL) is a heterogeneous group of disorders that result from the clonal proliferation and expansion of malignant lymphoid cells in the bone marrow, blood and other organs. Distinct clinicopathological ALL entities have been identified, resulting in the adoption of risk-oriented treatment approaches. Advances in ALL therapy have led to long-term survival rates of >80% in children. However, only ≈30–40% of adults achieve long-term disease-free survival. Contemporary ALL treatment programmes include induction, intensified consolidation, maintenance phases and CNS prophylaxis. The optimal treatment of Philadelphia chromosome-positive patients requires the addition of BCR-ABL tyrosine kinase inhibitors, such as imatinib, whereas allogeneic stem-cell transplantation remains the preferred approach for high-risk patients in first remission. Since only ≈38% of adult ALL patients are free of disease 5 years after diagnosis and the outcome of salvage chemotherapy is very poor (complete remission rates of 20–30%, median survival of 3–6 months), novel agents are desperately required. Of those currently in clinical studies, the outlook for sphingosomal vincristine, pegylated asparaginase (pegaspargase), liposomal annamycin, ABT-751, pemetrexed, talotrexin, nelarabine and the novel BCR-ABL kinase inhibitors is discussed.

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Authors and Affiliations

  1. Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

    Effrosyni Apostolidou & Yesid Alvarado

  2. Department of Haematology, University College Hospital Galway (UCHG), Galway, Ireland

    Ronan Swords

  3. Division of Hematology and Medical Oncology, University of Texas Health Science Center at San Antonio, CTRC Institute for Drug Development, 7979 Wurzbach Road, Suite 400, San Antonio, Texas 78229, USA

    Francis J. Giles

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  1. Effrosyni Apostolidou
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  2. Ronan Swords
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  4. Francis J. Giles
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Correspondence to Francis J. Giles.

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Apostolidou, E., Swords, R., Alvarado, Y. et al. Treatment of Acute Lymphoblastic Leukaemia. Drugs 67, 2153–2171 (2007). https://doi.org/10.2165/00003495-200767150-00004

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