Relapsed Acute Lymphoblastic Leukemia
Jasmeet Sidhu1,2,3, Manash Pratim Gogoi2, Shekhar Krishnan1,2,4
1Department of Pediatric Hematology and Oncology, Tata Medical Center, Kolkata, 700160, India.
Insights
Outcomes for childhood acute lymphoblastic leukemia (ALL) have improved, but relapsed ALL remains a significant challenge with static survival rates. New immunotherapies, cellular therapies, and precision oncology strategies are crucial for improving outcomes in relapsed ALL.
Area of Science:
- Pediatric Oncology
- Hematology
- Cancer Therapeutics
Background:
- Childhood acute lymphoblastic leukemia (ALL) survival rates exceed 85% globally.
- Outcomes for relapsed ALL remain poor at approximately 50%, contributing significantly to childhood cancer mortality.
- Early bone marrow relapse within 18 months portends a particularly poor prognosis.
Purpose of the Study:
- To highlight the persistent challenges in treating relapsed acute lymphoblastic leukemia (ALL).
- To emphasize the need for improved biological understanding of relapse and drug resistance mechanisms.
- To discuss the integration of novel therapeutic options and precision oncology strategies in relapsed ALL management.
Main Methods:
- Review of current treatment mainstays: chemotherapy, radiotherapy, and hematopoietic stem cell transplantation (HSCT).
- Exploration of emerging therapeutic options including immunotherapies and cellular therapies for relapsed ALL.
- Discussion of integrated precision oncology approaches for personalized treatment strategies.
Main Results:
- Despite overall improvements in ALL treatment, outcomes for relapsed cases have not significantly advanced.
- Newer strategies like immunotherapies and cellular therapies offer potential for improved outcomes.
- Precision oncology is increasingly utilized to tailor treatments for individual patients, particularly those with refractory disease.
Conclusions:
- There is a critical need for enhanced biological insights into ALL relapse and drug resistance.
- Innovative treatment strategies and global collaborations are essential to improve survival in relapsed ALL.
- Understanding the optimal application of novel therapies and precision medicine is imperative for advancing care in relapsed ALL.
Abstract:
Outcomes for children with acute lymphoblastic leukemia (ALL) have improved worldwide to >85%. For those who relapse, outcomes have remained static at ~50% making relapsed acute lymphoblastic leukemia one of the leading causes of death in childhood cancers. Those relapsing within 18 mo in the bone marrow have a particularly dismal outcome. The mainstay of treatment is chemotherapy, local radiotherapy with or without hematopoietic stem cell transplantation (HSCT). Improved biological understanding of mechanisms of relapse and drug resistance, use of innovative strategies to identify the most effective and least toxic treatment regimens and global partnerships are needed to improve outcomes in these patients. Over the last decade, new therapeutic options and strategies have been developed for relapsed ALL including immunotherapies and cellular therapies. It is imperative to understand how and when to use these newer approaches in relapsed ALL. Increasingly, integrated precision oncology strategies are being used to individualize treatment of patients with relapsed ALL, especially in patients with poor response disease.
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