How to Manage Philadelphia-Positive Acute Lymphoblastic Leukemia in Resource-Constrained Settings
Recent studies have indicated that more than half of adult patients newly diagnosed with Ph+ ALL can now achieve a cure. However, determining the most suitable protocol for less-resourced settings can be challenging. In these situations, we must consider the potential for treatment toxicity and limi...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-12-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/24/5783 |
| _version_ | 1797381684260241408 |
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| author | Wellington Silva Eduardo Rego |
| author_facet | Wellington Silva Eduardo Rego |
| author_sort | Wellington Silva |
| collection | DOAJ |
| description | Recent studies have indicated that more than half of adult patients newly diagnosed with Ph+ ALL can now achieve a cure. However, determining the most suitable protocol for less-resourced settings can be challenging. In these situations, we must consider the potential for treatment toxicity and limited access to newer agents and alloSCT facilities. Currently, it is advisable to use less intensive induction regimens for Ph+ ALL. These regimens can achieve high rates of complete remission while causing fewer induction deaths. For consolidation therapy, chemotherapy should remain relatively intensive, with careful monitoring of the BCR-ABL1 molecular transcript and minimal residual disease. AlloSCT may be considered, especially for patients who do not achieve complete molecular remission or have high-risk genetic abnormalities, such as IKZF1-plus. If there is a loss of molecular response, it is essential to screen patients for ABL mutations and, ideally, change the TKI therapy. The T315I mutation is the most common mechanism for disease resistance, being targetable to ponatinib. Blinatumomab, a bispecific antibody, has shown significant synergy with TKIs in treating this disease. It serves as an excellent salvage therapy, aside from achieving outstanding results when incorporated into the frontline. |
| first_indexed | 2024-03-08T20:55:59Z |
| format | Article |
| id | doaj.art-aa1cbe1326a24aefa6b20687f85d11d2 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-08T20:55:59Z |
| publishDate | 2023-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-aa1cbe1326a24aefa6b20687f85d11d22023-12-22T13:58:51ZengMDPI AGCancers2072-66942023-12-011524578310.3390/cancers15245783How to Manage Philadelphia-Positive Acute Lymphoblastic Leukemia in Resource-Constrained SettingsWellington Silva0Eduardo Rego1Discipline of Hematology, Hospital das Clínicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-010, BrazilDiscipline of Hematology, Hospital das Clínicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-010, BrazilRecent studies have indicated that more than half of adult patients newly diagnosed with Ph+ ALL can now achieve a cure. However, determining the most suitable protocol for less-resourced settings can be challenging. In these situations, we must consider the potential for treatment toxicity and limited access to newer agents and alloSCT facilities. Currently, it is advisable to use less intensive induction regimens for Ph+ ALL. These regimens can achieve high rates of complete remission while causing fewer induction deaths. For consolidation therapy, chemotherapy should remain relatively intensive, with careful monitoring of the BCR-ABL1 molecular transcript and minimal residual disease. AlloSCT may be considered, especially for patients who do not achieve complete molecular remission or have high-risk genetic abnormalities, such as IKZF1-plus. If there is a loss of molecular response, it is essential to screen patients for ABL mutations and, ideally, change the TKI therapy. The T315I mutation is the most common mechanism for disease resistance, being targetable to ponatinib. Blinatumomab, a bispecific antibody, has shown significant synergy with TKIs in treating this disease. It serves as an excellent salvage therapy, aside from achieving outstanding results when incorporated into the frontline.https://www.mdpi.com/2072-6694/15/24/5783acute lymphoblastic leukemiaPhiladelphia chromosometyrosine-kinase inhibitorblinatumomaballogeneic stem-cell transplantation |
| spellingShingle | Wellington Silva Eduardo Rego How to Manage Philadelphia-Positive Acute Lymphoblastic Leukemia in Resource-Constrained Settings Cancers acute lymphoblastic leukemia Philadelphia chromosome tyrosine-kinase inhibitor blinatumomab allogeneic stem-cell transplantation |
| title | How to Manage Philadelphia-Positive Acute Lymphoblastic Leukemia in Resource-Constrained Settings |
| title_full | How to Manage Philadelphia-Positive Acute Lymphoblastic Leukemia in Resource-Constrained Settings |
| title_fullStr | How to Manage Philadelphia-Positive Acute Lymphoblastic Leukemia in Resource-Constrained Settings |
| title_full_unstemmed | How to Manage Philadelphia-Positive Acute Lymphoblastic Leukemia in Resource-Constrained Settings |
| title_short | How to Manage Philadelphia-Positive Acute Lymphoblastic Leukemia in Resource-Constrained Settings |
| title_sort | how to manage philadelphia positive acute lymphoblastic leukemia in resource constrained settings |
| topic | acute lymphoblastic leukemia Philadelphia chromosome tyrosine-kinase inhibitor blinatumomab allogeneic stem-cell transplantation |
| url | https://www.mdpi.com/2072-6694/15/24/5783 |
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