Novel strategies in the treatment of acute lymphoblastic leukaemia

Abstract

The outcome of paediatric acute lymphoblastic leukaemia is excellent, with a 90% overall survival rate. However, the overall survival of adults with acute lymphoblastic leukaemia with standard chemotherapy is only 40–50%. This outcome is typically worse with increasing age. Given this prognosis, novel therapies and strategies are needed to improve outcomes. In The Lancet Haematology, two different strategies are employed by the UKALL group: (1) the addition of the monoclonal anti-CD20 antibody, rituximab, to standard induction therapy in adults aged 25–65 years with precursor B-cell acute lymphoblastic leukaemia; 1 Marks DI Kirkwood AA Rowntree CJ et al. Addition of four doses of rituximab to standard induction chemotherapy in adult patients with precursor B-cell acute lymphoblastic leukaemia (UKALL14): a phase 3, multicentre, randomised controlled trial. Lancet Haematol. 2022; 9: e262-e275 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar and (2) the use of in-vivo T-cell depleted reduced intensity allogeneic haematopoietic stem-cell transplantation (HSCT) in first remission for patients aged 41 years and older or for patients younger than 41 years considered unfit for a myeloablative allograft. 2 Marks DI Clifton-Hadley L Copland M et al. In-vivo T-cell depleted reduced-intensity conditioned allogeneic haematopoietic stem-cell transplantation for patients with acute lymphoblastic leukaemia in first remission: results from the prospective, single-arm evaluation of the UKALL14 trial. Lancet Haematol. 2022; 9: e276-e288 Summary Full Text Full Text PDF PubMed Google Scholar Addition of four doses of rituximab to standard induction chemotherapy in adult patients with precursor B-cell acute lymphoblastic leukaemia (UKALL14): a phase 3, multicentre, randomised controlled trialStandard of care plus four doses of rituximab did not significantly improve event-free survival over standard of care. Rituximab is beneficial in acute lymphoblastic leukaemia but four doses during induction is likely to be insufficient. Full-Text PDF Open AccessIn-vivo T-cell depleted reduced-intensity conditioned allogeneic haematopoietic stem-cell transplantation for patients with acute lymphoblastic leukaemia in first remission: results from the prospective, single-arm evaluation of the UKALL14 trialFMA reduced-intensity conditioned allogeneic HSCT in older patients with acute lymphoblastic leukaemia in first complete remission provided good disease control with moderate GVHD, resulting in better-than-expected event-free survival and overall survival in this high-risk population. Strategies to reduce infection-related TRM will further improve outcomes. Full-Text PDF Open Access