State-of-the-art therapy for adult Philadelphia chromosome-negative acute lymphoblastic leukemia

Abstract

With pediatric-inspired chemotherapy, the survival of adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia (ALL) has improved. For standard-risk patients in the first complete remission (CR1), pediatric-inspired chemotherapy may be superior than allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, increased dose of steroid, vincristine, and L-asparaginase (L-Asp) in pediatric-inspired chemotherapy induces adverse events in certain number of adult ALL patients. Especially, the administration of L-Asp is often reduced to 60-70% for thrombosis or liver dysfunction. The optimal dose of these agents for adult ALL patients with higher age is under investigation. Moreover, minimal residual disease (MRD) >10-4 is a poor prognostic factor. The time point for the assessment of MRD should be defined. For relapsed or refractory ALL, inotuzumab ozogamicin and blinatumomab are promising antibody agents that diminish MRD and proceed to allo-HSCT.