title: Advances in the Genetics and Therapy of Acute Lymphoblastic Leukemia.
abstract: Acute lymphoblastic leukemia (ALL) remains an important cause of morbidity in children and adults. In this article, we highlight advances in the genetics and therapy of three key subtypes of ALL: T-cell ALL, BCR-ABL1 (Philadelphia [Ph] chromosone-positive), and Ph-like ALL. T-ALL is an aggressive disease that accounts for about 15% and 25% of ALL among pediatric and adult cohorts, respectively, and exhibits a multistep nature of cancer initiation and progression. The integration of cytogenetics, molecular biology, and immunophenotype analyses has led to the identification of defined T-ALL subgroups, such as early T-cell precursor ALL and novel lesions with a prognostic role, for which specific inhibitors are being developed. Ph-positive ALL was historically regarded as a subtype of ALL with a poor prognosis, and allogeneic stem cell transplant was recommended for all patients who could undergo this procedure. The deep complete responses seen with combination tyrosine kinase inhibitors (TKIs) and chemotherapy in Ph-positive ALL, and the reports of long-term survival among some patients not undergoing allogeneic stem cell transplant, has raised the question of whether there is a subset of patients who could be cured without this intervention. Ph-like ALL is a subtype of B-progenitor ALL common among older children and adults and associated with a diverse range of genetic alterations that activate kinase signaling. Ph-like ALL is also associated with poor outcome, for which precision medicine trials identifying kinase alterations and testing TKI therapy are being developed.
authors.affiliation: From the Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy; Chao Family Comprehensive Cancer Center, School of Medicine, University of California, Irvine, CA; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN.
authors.forename: Sabina
authors.initials: S
authors.lastname: Chiaretti
authors.affiliation: From the Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy; Chao Family Comprehensive Cancer Center, School of Medicine, University of California, Irvine, CA; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN.
authors.forename: Valentina
authors.initials: V
authors.lastname: Gianfelici
authors.affiliation: From the Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy; Chao Family Comprehensive Cancer Center, School of Medicine, University of California, Irvine, CA; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN.
authors.forename: Susan M
authors.initials: SM
authors.lastname: O'Brien
authors.affiliation: From the Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy; Chao Family Comprehensive Cancer Center, School of Medicine, University of California, Irvine, CA; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN.
authors.forename: Charles G
authors.initials: CG
authors.lastname: Mullighan
mesh_terms: D000328:Adult; D002648:Child; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D010677:Philadelphia Chromosome; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000235:genetics* / Q000473:pathology; D011379:Prognosis; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D012074:Remission Induction
chemical_list: D047428:Protein Kinase Inhibitors