T-cell acute lymphoblastic leukemia: promising experimental drugs in clinical development

ABSTRACT

Introduction

Despite advances in treatment approaches in acute lymphoblastic leukemia (ALL), the prognosis of adults with newly diagnosed T-ALL remains poor, as well as that of adults and children with relapsed disease. Novel targeted therapies are therefore needed.

Areas covered

This review summarizes promising emerging strategies for the treatment of T-ALL.

Expert opinion

The recent molecular characterization of T-ALL has led to the identification of new therapeutic targets. Small-molecules inhibitors and other targeted therapies have therefore been recently developed and are currently under clinical investigations. Similarly, first studies involving monoclonal antibodies and chimeric antigen receptor (CAR) T cells have shown encouraging results. Improvement of outcome with these novel approaches, eventually combined with current standard chemotherapy, is therefore expected in a near future in T-ALL.

KEYWORDS:

• T-cell acute lymphoblastic leukemia
• targeted therapy
• CAR T cells
• monoclonal antibodies
• small-molecule inhibitors
• prognosis

Article highlights

• T-ALL is a heterogeneous subtype of ALL characterized by immunophenotypic and molecular high diversity.

• Nelarabine is the only recent chemotherapeutic agent integrated to optimize frontline therapy in T-ALL.

• A personalized targeting approach based on leukemic cell molecular expression and on antigenic expression is warranted in relapsed/refractory T-ALL.

• Small-molecules inhibitors and other targeted therapies are currently under clinical investigations.

First immunotherapy studies involving monoclonal antibodies and CAR T cells have shown encouraging results.

This box summarizes key points contained in the article.

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.