Philadelphia-like acute lymphoblastic leukemia: the journey from molecular background to the role of bone marrow transplant—review article

Abstract

Philadelphia chromosome-like (Ph-like) ALL is a recent subtype of acute lymphoblastic leukemia. Although it does not express the BCR-ABL fusion gene, it has a behavior like true BCR/ABL1–positive cases. This subtype harbors different molecular alterations most commonly CRLF2 rearrangements. Most cases of Ph-like ALL are associated with high white blood cell count, high minimal residual disease level after induction therapy, and high relapse rate. Efforts should be encouraged for early recognition of Ph-like ALL to enhance therapeutic strategies. Recently, many trials are investigating the possibility of adding the tyrosine kinase inhibitor (TKI) to chemotherapy to improve clinical outcomes. The role and best timing of allogeneic bone marrow transplant in those cases are still unclear. Precision medicine should be implemented in the treatment of such cases. Here in this review, we summarize the available data on Ph-like ALL

Rare Drivers at Low Prevalence with High Cancer Effects in T-Cell and B-Cell Pediatric Acute Lymphoblastic Leukemia

“…The mutations of B-cell ALL that are at high frequency as well as high cancer effect have been identified with poor prognosis and therapeutic outcomes, such as those in JAK2 , FLT3 , and genes encoding RAS proteins. These mutations have been associated with Ph-like B-ALL—a poor prognosis group [ 36 ]. Mutations in genes such as IL7R , XBP1 , and TOX also exhibit substantial cancer effects in B-cell ALL, indicating major roles in the development of respective leukemias.…”