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New Approaches to Treating Challenging Subtypes of ALL in AYA Patients

  • Acute Lymphocytic Leukemias (K Ballen and M Keng, Section Editors)
  • Published:
Current Hematologic Malignancy Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The treatment of acute lymphoblastic leukemia (ALL) in adolescent and young adult (AYA) patients has markedly improved with the adoption of pediatric-inspired protocols. However, there remain several subtypes of ALL that represent significant therapeutic challenges. Here, we review the current evidence guiding treatment of Philadelphia chromosome-positive (Ph+), Philadelphia chromosome-like (Ph-L), and early T-precursor (ETP) ALL in the AYA population.

Recent Findings

Clinical trials in Ph + ALL have demonstrated the superior efficacy of second- and third-generation tyrosine kinase inhibitors (TKIs) to induce and maintain remission. Current efforts now focus on determining the durability of these remissions and which patients will benefit from transplant. For Ph-like and ETP ALL, recent studies are investigating the addition of novel agents to standard treatment.

Summary

The treatment of Ph + ALL has significantly improved with the addition of potent TKIs. However, the treatment of Ph-like and ETP ALL remains a challenge. At this time, the judicious use of allogenic transplant is the only current approach to modify this increased risk.

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Funding

JW is supported by 5K12CA139160-10.

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  1. Department of Medicine, University of Chicago Medicine, 900 E. 57th Street, 8th Floor, Chicago, IL, 60637, USA

    Kevin Prescott, Michael Jacobs, Wendy Stock & Joseph Wynne

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  2. Michael Jacobs
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Correspondence to Joseph Wynne.

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Dr. Prescott has nothing to disclose. Dr. Jacobs has nothing to disclose. Dr. Stock reports personal fees from AMGEN, personal fees from ABBVIE, personal fees from PFIZER, personal fees from JAZZ, personal fees from ADAPTIVE BIOTECHNOLOGIES, during the conduct of the study; personal fees from ASTELLAS, personal fees from UP TO DATE, outside the submitted work. Dr. Wynne reports personal fees from Servier, outside the submitted work.

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This article is part of the Topical Collection on Acute Lymphocytic Leukemias

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Prescott, K., Jacobs, M., Stock, W. et al. New Approaches to Treating Challenging Subtypes of ALL in AYA Patients. Curr Hematol Malig Rep 15, 424–435 (2020). https://doi.org/10.1007/s11899-020-00597-y

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