Emerging Treatment Options for Acute Lymphoblastic Leukemia: Focus on CAR T-Cell Therapy

J Natl Compr Canc Netw. 2018 May;16(5S):651-655. doi: 10.6004/jnccn.2018.0048.

Abstract

Acute lymphoblastic leukemia (ALL) comprises a heterogeneous group of diseases with different morphologic, cytogenetic, and molecular subgroups, some of which have significant therapeutic implications. It typically presents with an aggressive clinical course, and among adults, responds poorly to standard chemotherapy, and carries a high risk for relapse. Despite the significant progress made in inducing remission, frequent relapses remain a challenge. Novel drugs, such as potent later-generation tyrosine kinase inhibitors, antibody-drug conjugates, bispecific monoclonal antibodies, and chimeric antigen receptor (CAR) T-cell therapies, are being investigated in patients with ALL. This summary describes therapies currently approved for the treatment of patients with ALL, identifies emerging targeted immunotherapies for patients with ALL, and discusses adverse events and mechanisms of resistance.

MeSH terms

  • Antibodies, Bispecific / pharmacology
  • Antibodies, Bispecific / therapeutic use
  • Antibodies, Monoclonal, Humanized / pharmacology
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antineoplastic Agents / pharmacology
  • Antineoplastic Agents / therapeutic use*
  • Combined Modality Therapy / adverse effects
  • Combined Modality Therapy / methods
  • Combined Modality Therapy / standards
  • Drug Resistance, Neoplasm / immunology
  • Humans
  • Immunotherapy, Adoptive / adverse effects
  • Immunotherapy, Adoptive / methods*
  • Immunotherapy, Adoptive / standards
  • Inotuzumab Ozogamicin
  • Neoplasm Recurrence, Local / immunology
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / therapy*
  • Practice Guidelines as Topic
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / immunology
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / mortality
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / pathology
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / therapy*
  • Randomized Controlled Trials as Topic
  • Receptors, Antigen, T-Cell / immunology*
  • Remission Induction / methods
  • Survival Rate
  • Treatment Outcome
  • Tumor Burden / immunology

Substances

  • Antibodies, Bispecific
  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents
  • Receptors, Antigen, T-Cell
  • blinatumomab
  • Inotuzumab Ozogamicin