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Recent Advances in the Management of Acute Lymphoblastic Leukaemia

  • Leukemia (PH Wiernik, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

The last few years have seen unprecedented advances in treatment options for patients diagnosed with acute lymphoblastic leukaemia (ALL) in adulthood. New targeted drug therapies have been shown in randomised trials to offer significant survival improvements above standard-of-care (SoC) for relapsed disease, whilst being relatively well tolerated. Chimeric antigen receptor T cell therapy (CAR-T) has offered spectacular promise amongst the young adult population, with the possibility of cure for refractory disease. It has reversed the paradigm that transplant is the only curative option at relapse. Data is awaited regarding its effectiveness in the older adult population. Nelarabine represents an advance, but there remains a pressing need to develop new therapies with efficacy against T-ALL, especially in the relapse setting.

Outcomes for younger adults have improved with the adoption of paediatric-like regimens, with a focus on dose intensity and heavy use of pegylated asparaginase. Defining who falls into the “young adult” category and would benefit from this approach remains a controversial area. In elderly patients with ALL, the introduction of tyrosine kinase inhibitors (TKIs) and reduction in standard chemotherapy intensity (especially for those with Philadelphia-positive disease) have significantly reduced treatment-associated mortality and resulted in durable remissions with good quality of life.

Bone marrow transplantation remains a key therapy in adult ALL, and is still the treatment of choice for relapsed disease. The mortality associated with a myeloablative approach can be substantially lowered by reduced intensity conditioning, without an apparently significant reduction in efficacy.

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  1. Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Trust, Bristol, UK

    Katharine A. Hodby BMBCh, PhD & David I. Marks MB, BS, PhD

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David I. Marks has received speaker’s honoraria from Pfizer, Amgen, and Novartis, and has participated on advisory boards for Pfizer and Novartis.

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Hodby, K.A., Marks, D.I. Recent Advances in the Management of Acute Lymphoblastic Leukaemia. Curr. Treat. Options in Oncol. 21, 23 (2020). https://doi.org/10.1007/s11864-020-0712-8

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