Frontline treatment of adults with newly diagnosed B-cell acute lymphoblastic leukaemia.

In the past decade, there has been considerable progress in the treatment of adults with newly diagnosed B-cell acute lymphoblastic leukaemia. This evolution is the product of a more profound understanding of acute lymphoblastic leukaemia biology, innovations in measurable residual disease quantification that led to precise disease-risk stratification, adoption of contemporary paediatric-inspired regimens, inclusion of tyrosine kinase inhibitors in the treatment of Philadelphia chromosome-positive acute lymphoblastic leukaemia, and the introduction of immunotherapy in the frontline setting. Nevertheless, outcomes of acute lymphoblastic leukaemia in adults are inferior compared with those of children, with excessive rates of treatment failure, and therapy-related morbidity and mortality. Simultaneously, transplant consolidation has continued to be used frequently for high-risk adults with acute lymphoblastic leukaemia in first complete remission. Considering the rapid pace of evolution in acute lymphoblastic leukaemia management, novel trial designs are warranted to accelerate advancements and streamline approaches. Here, we summarise progress in the treatment of adults with newly diagnosed acute lymphoblastic leukaemia, which adds to previously published guidelines by focusing specifically on first-line decisions for B-cell acute lymphoblastic leukaemia and how to best personalise treatment. This Viewpoint also includes experiences with regimens and testing approaches currently available not only in Europe, but also on multiple continents with different practices and resources.
Competing Interests: Declaration of interests IA reports research support from AbbVie and MacroGenics and being on advisory boards for Gilead/Kite, Amgen, Jazz, Syndax, Wugen, Takeda, and Pfizer. GJR is a consultant for Agios, Amgen, Amphivena, Astex, Celator, Celgene, Clovis Oncology, CTI BioPharma, Genoptix, Immune Pharmaceuticals, Janssen Pharmaceuticals, Juno, MedImmune, MEI Pharma, Onconova, Pfizer, Roche, and Sunesis; receives research funding from AbbVie, BMS, Teva, and Karyopharm; is an advisory board member or consultant for Novartis, AbbVie, BeiGene, BerGenBio, Arcellx, Jazz Pharmaceuticals, Syros, BMS, Genentech, ImmunoGen, AstraZeneca, Kura, Ryvu, Magenta, and Qihan Zentalis; and has provided research support to Janssen. RB reports participation in meetings and advisory boards (including fees, travel, and accommodations) for Amgen and Incyte. NB reports honorarium from Amgen, Celgene, Jazz Pharmaceuticals, and Pfizer; and has a consulting or advisory role for Amgen, Novartis, Pfizer, and Servier. DJD is a consultant for Amgen, Autolus, Agios, Blueprint, Forty-Seven, Gilead, Incyte, Jazz, Novartis, Pfizer, Servier, and Takeda; has received research funding from AbbVie, Glycomimetics, Novartis, and Blueprint Pharmaceuticals; is on a data safety monitoring board for Daiichi Sankyo and FibroGen; and is a member of Mt Sinai Myeloproliferative Neoplasms Research Consortium. SF reports research support from Amgen and Pfizer; speaker's honorarium from Amgen, Pfizer, Astellas, Jazz, Gilead/Kite, and Novartis; advisory board membership for Amgen, Pfizer, Astellas, Jazz, and Gilead/Kite. NG reports honoraria from Amgen, Pfizer, Kite/Gilead, Jazz Pharmaceuticals, Incyte, Autolus, Clinigen Group, and Servier; research funding from Amgen, Pfizer, Novartis, Servier, Jazz Pharmaceuticals), Incyte, and Clinigen Group. ACL reports consulting or advisory role for Amgen, Pfizer, Sanofi, Kite, and Takeda; research funding from Astellas Pharma, Pharmacyclics, Kite/Gilead, Kadmon, Amgen, Autolus, Talaris; and travel, accommodations, and expenses from Amgen. SML reports honoraria from Astellas, Daiichi Sankyo, Novartis, Marker Therapeutics, AbbVie, Amgen, Bristol-Myers Squibb, Pluristem, Syros, and Agios; and research funding from BioSight (previous funding from Onconova, Celgene, Hoffman LaRoche, and Kura [travel included]). TM reports travel grants from Amgen, Jazz, Pfizer, Bayer, Kyowa Kirin, Celgene/BMS, Kite/Gilead, Janssen, and Takeda; honoraria for advisory board meetings from Kite/Gilead, Amgen, Novartis, Pfizer, Celgene/BMS, Daiichi Sankyo, Atara, Roche, and Janssen; honoraria for lectures from Kite/Gilead, Takeda, Janssen, Roche, Servier, Novartis, Celgene/BMS, Pfizer, and Incyte; and research funding from Janssen, AstraZeneca, and Novartis. JP reports consulting fees from AffyImmune Therapeutics, Amgen, Autolus, Be Biopharma, BeiGene, Bright Pharmaceutical Services, Curocell, Kite, Medpace, Minerva Biotechnologies, Pfizer, Servier, Sobi, Synthekine, and Takeda; honoraria from OncLive, Physician Education Resource, and MJH Life Sciences; serves on scientific advisory board of Allogene Therapeutics and Artiva Biotherapeutics; received institutional research funding from Autolus, Genentech, Fate Therapeutics, Incyte, Servier, and Takeda. ACS reports honoraria from Celgene, Amgen, Pfizer, Novartis, and Jazz Pharmaceuticals; and research funding from Celgene, Amgen, Agios, and Pfizer. BS reports honoraria from Pharmacyclics/Janssen, Spectrum/Acrotech, BeiGene, Gilead Sciences; consulting or advisory role for Adaptive Biotechnologies, Bristol Myers Squibb/Celgene, Novartis, Pfizer, Amgen, Precision Biosciences, Kite, Jazz Pharmaceuticals, Century Therapeutics, Deciphera, Autolus, Lilly, Pepromene; research funding from Incyte, Jazz Pharmaceuticals, Kite/Gilead, and Servier; and travel, accommodations, and expenses from Celgene, Novartis, Pfizer, Janssen, Seattle Genetics, AstraZeneca, Stemline Therapeutics, and Kite. EJ reports research grants and consultancy fees from AbbVie, Adaptive Biotechnologies, Amgen, Ascentage, Autolus, Bristol Myers Squibb, Hikma, Genentech, Jazz, Kite, Novartis, Pfizer, and Takeda.
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