Recent advances in acute lymphoblastic leukemia

Abstract

 Although the outcome of patients with ALL has dramatically improved, we still need novel therapy to treat refractory cases and reduced toxicities of conventional therapy in ALL patients. Imatinib-combined with chemotherapy resulted in a good outcome and some patients with Ph-positive ALL may not need HSCT. Tyrosine kinase inhibitors could also be used for those with Ph-like ALL having ABL and PDGFRB translocations. Immunotherapy such as blinatumomab bispecific antibody and CAR-T cell treatment have been developed and are recently covered by health insurance in Japan. NUDT15 polymorphism is appreciated as a major role player in 6-mercaptopirine metabolism and genetic polymorphism examination is recently covered by health insurance in Japan. The prevalence of cancer predisposition genes has recently been extensively studied and some genes such as TP53 is also involved in ALL leukemogenesis and therapy-related cancer may be another important issue in leukemia treatment. Thus, the development of genomic medicine will not only expand our knowledge but also contribute to personalized medicine in the context of leukemogenesis, sensitivity to drugs, toxicity, and subsequent occurrence of secondary cancer.