Pharmacotherapy for adult acute lymphoblastic leukemia: an update from recent clinical trials and future directions

In adults, acute lymphoblastic leukemia (ALL) is an aggressive malignancy that, while initially highly responsive to chemotherapy, has a high relapse rate and poor survival. The role of allogeneic transplantation in ALL, the use of pediatric strategies in adolescents and young adults, the administration of rituximab for CD20-positive B-lineage ALL, tyrosine kinase inhibitors for Philadelphia chromosome-positive ALL, and nelarabine for T-lineage ALL will be discussed in this article. Promising agents reported in early clinical trials since 2010 are herein highlighted, including antibody-drug and antibody-immunotoxins; blinatumomab (bispecific T-cell engaging antibody); secondand third-generation tyrosine kinase inhibitors; mTOR inhibitors; bortezomib (a proteasome inhibitor); liposomal vincristine (reformulated chemotherapy); and decitabine (a hypomethylating agent). Progress has been made over the last few years in the development of novel therapeutics in ALL and appears to be setting the stage for even greater progress over the next 5–10 years.