RT Book, Section
A1 Rafei, Hind
A1 Konoplev, Sergej N.
A1 Wang, Sa A.
A1 Short, Nicholas J.
A1 Kantarjian, Hagop M.
A1 Jabbour, Elias J.
A2 Kantarjian, Hagop M.
A2 Wolff, Robert A.
A2 Rieber, Alyssa G.
SR Print(0)
ID 1190831824
T1 Acute Lymphoblastic Leukemia
T2 The MD Anderson Manual of Medical Oncology, 4e
YR 2022
FD 2022
PB McGraw Hill Education
PP New York, NY
SN 9781260467642
LK hemonc.mhmedical.com/content.aspx?aid=1190831824
RD 2024/04/19
AB KEY  CONCEPTSAcute  lymphoblastic  leukemia  (ALL)  is  classified  into  B-cell  ALL,  T-cell  ALL,  and  natural  killer  cell  ALL.  Cytogenetics  are  key  in  the  diagnosis  of  ALL  because  they  hold  a  predictive  and  prognostic  value.  A  Philadelphia  chromosome–like  signature  that  lacks  the  expression  of  BCR-ABL1  fusion  protein  but  does  have  a  gene  expression  profile  similar  to  BCR-ABL1+  ALL  has  been  recently  defined.Measurement  of  measurable  residual  disease  (MRD)  using  multiparameter  flow  cytometry,  quantitative  polymerase  chain  reaction,  and  next-generation  sequencing  is  standard  of  care  in  the  treatment  of  patients  with  ALL,  and  it  holds  prognostic  as  well  as  predictive  significance.  Treatment  of  patients  with  MRD-positive  disease  after  achievement  of  response  consists  of  the  use  of  immunotherapy,  such  as  blinatumomab  or  combinatorial  agents.The  frontline  therapy  of  patients  with  ALL  consists  of  four  major  components:  induction  of  remission,  consolidation,  maintenance,  and  central  nervous  system  prophylaxis.  Intensive  induction  chemotherapy  regimens  are  modeled  after  either  the  pediatric-inspired  roadmap  regimens  or  the  hyper-CVAD  (hyperfractionated  cyclophosphamide,  vincristine,  doxorubicin,  and  dexamethasone)  regimen.  Consolidation  depends  on  the  risk  category  and  consists  of  either  consolidation  chemotherapy  (e.g.,  high-dose  methotrexate  and  cytarabine)  or  allogeneic  hematopoietic  stem  cell  transplant.  Maintenance  consists  of  POMP  (Purinethol,  Oncovin,  methotrexate,  and  prednisone)  or  DOMP  (Dexamethasone,  Purinethol,  Oncovin,  and  methotrexate)  chemotherapy  for  2  to  3  years.  Clinical  trials  are  evaluating  the  use  of  novel  agents,  such  as  antibody–drug  conjugates  and  bispecific  antibodies,  in  the  frontline  setting.The  combination  of  chemoimmunotherapy  is  the  mainstay  of  treatment  of  patients  with  ALL  and  is  a  field  of  ongoing  research  to  identify  the  best  combinations  as  well  as  timing  of  their  use.In  adolescents  and  young  adults,  pediatric  regimens  and  the  hyper-CVAD  regimen  showed  similar  complete  remission  rates,  remission  duration,  and  survival  outcomes.The  role  of  allogeneic  hematopoietic  stem  cell  transplantation  (AHSCT)  in  first  remission  remains  currently  valid  in  certain  high-risk  circumstances,  such  as  (1)  KMT2A-rearranged  ALL,  (2)  early  T-cell  precursor  ALL,  and  (3)  ALL  with  complex  cytogenetics  and  hypodiploidy.In  the  salvage  setting,  a  number  of  novel  agents  have  been  approved,  including  monoclonal  antibodies,  bispecific  antibodies,  and  chimeric  antigen  receptor  T-cell  therapies.