Philadelphia chromosome negative B-cell acute lymphoblastic leukemia in older adults: Current treatment and novel therapies

Publication date: Available online 3 August 2017 Source:Best Practice & Research Clinical Haematology Author(s): Kristen M. O'Dwyer, Jane L. Liesveld The management of older adult patients with Philadelphia chromosome negative (Ph-) B-acute lymphoblastic leukemia (ALL) remains a challenge. Older adults with Ph- B-ALL have the highest rates of treatment failure and treatment complications, and thus there is no standard treatment approach in this clinical setting. Approximately 16% of patients with newly diagnosed Philadelphia chromosome negative (Ph-) acute lymphoblastic leukemia (ALL) are aged 60 years or older [2]. The five-year overall survival outcomes for this older cohort of patients are unfavorable at approximately 20%, and there has been no improvement in their survival in decades [3]. The main challenge in managing older patients with ALL is achieving the appropriate balance between efficacy of treatment and the toxicity. Intensive multi-agent chemotherapy that is highly effective in younger adults is limited by toxicity in older adults. New classes of agents, bi-specific T-cell engager (BiTE) monoclonal antibody and antibody drug conjugates (ADC) have been introduced into the treatment of ALL, and these agents have demonstrated solid responses and manageable toxicity in patients of all ages with relapsed refractory ALL. These newer immunotherapy agents have the potential to improve the treatment of older adults in the frontline setting. This review focuse...
Source: Best Practice and Research Clinical Haematology - Category: Hematology Source Type: research