Acute Lymphoblastic Leukemia, Version 2.2015

Abstract

Treatment of acute lymphoblastic leukemia (ALL) continues to advance, as evidenced by the improved risk stratification of patients and development of newer treatment options. Identification of ALL subtypes based on immunophenotyping and cytogenetic and molecular markers has resulted in the inclusion of Philadelphia-like ALL and early T-cell precursor ALL as subtypes that affect prognosis. Identification of Ikaros mutations has also emerged as a prognostic factor. In addition to improved prognostication, treatment options for patients with ALL have expanded, particularly with regard to relapsed/refractory ALL. Continued development of second-generation tyrosine kinase inhibitors and the emergence of immunotherapy, including blinatumomab and chimeric antigen receptor T-cell therapy, have improved survival. Furthermore, incorporation of minimal residual disease (MRD) monitoring has shown insight into patient outcomes and may lead to treatment modification or alternative treatment strategies in select populations. This excerpt focuses on the sections of the ALL guidelines specific to clinical presentation and diagnosis, treatment of relapsed/refractory ALL, and incorporation of MRD monitoring. To view the most recent complete version of these guidelines, visit NCCN.org. (J Natl Compr Canc Netw 2015;13:1240-1279 NCCN Categories of Evidence and ConsensusCategory 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2B: Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate. Category 3: Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate. These guidelines are also available on the Internet. For the latest update, visit NCCN.org.

Cysteine and glycine-rich protein 2 (CSRP2) transcript levels correlate with leukemia relapse and leukemia-free survival in adults with B-cell acute lymphoblastic leukemia and normal cytogenetics

“…92 subjects (55%) received an allotransplant, 28 from an HLA-identical sibling, 1 from an HLA-matched-unrelated donor and 63 from HLA-haplotype-matched related donors [36, 37]. Complete remission, refractory disease, relapse and risk-stratification were defined as described [2]. Relapse-free survival (RFS) was determined from the date of first complete remission to the date of first relapse.…”

“…Although survival of adults with B-cell ALL has improved relapse is an important problem. Prognostic models for relapse include age, WBC levels at diagnosis, immune phenotype, cytogenetics, mutational landscape, response to induction therapy and measureable residual disease (MRD) after completing therapy [2]. Adverse cytogenetic and mutations include hypo-diploidy (< 44 chromosomes), MLL /11q23 translocations, complex cytogenetics (≥ 5 abnormalities) and t (9; 22) and/or BCR-ABL1 [2].…”

“…Prognostic models for relapse include age, WBC levels at diagnosis, immune phenotype, cytogenetics, mutational landscape, response to induction therapy and measureable residual disease (MRD) after completing therapy [2]. Adverse cytogenetic and mutations include hypo-diploidy (< 44 chromosomes), MLL /11q23 translocations, complex cytogenetics (≥ 5 abnormalities) and t (9; 22) and/or BCR-ABL1 [2]. However, about one-half of adults with B-cell ALL have none of the adverse prognostic variables at diagnosis making predicting relapse difficult, especially so in those with normal cytogenetics [3, 4].…”

Acute lymphoblastic leukemia following temozolomide treatment in a patient with glioblastoma: A case report and review of the literature

“…272; dilution, 1:100; Fuzhou Maixin Biotech Co., Ltd.). Staining was performed as described previously (21). Bone marrow cytogenetics revealed a normal male karyotype (Fig.…”

PEG-asparaginase in BFM-90 regimen improves outcomes in adults with newly diagnosed lymphoblastic lymphoma

“…The two drugs were similar in event-free survival, adverse events (AEs), and infection occurrence (11,13). PEG-ASP was approved for treatment of ALL patients allergic to L-ASP by the US Food and Drug Administration (FDA) in 1994, and has been used as first-line treatment for adult and children ALL since 2006 (14,15). However, the efficacy and safety of PEG-ASP-based pediatric regimens in adult LBL have not been well studied.…”