Adult acute lymphoblastic leukemia in a resource-constrained setting: outcomes after expansion of genetic evaluation

Silva, Wellington F; Amano, Mariane Tami; Perruso, Luiza L; Cordeiro, Maria Gabriella; Kishimoto, Renata Kiyomi; Leal, Aline de Medeiros; Nardinelli, Luciana; Bendit, Israel; Velloso, Elvira Drp; Rego, Eduardo Magalhães; Rocha, Vanderson

doi:10.1080/16078454.2022.2052602

Cited by 7 publications

(7 citation statements)

References 42 publications

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“…The underlying cause for this is unknown although several hypotheses exist, including socioeconomic disparities, environmental risks, and genetic variants. 3 , 5 - 8 …”

Section: Resultsmentioning

confidence: 99%

“… 14 Basic treatment is generally guaranteed. However, high-cost therapies and medications like monoclonal antibodies (MoAbs) and allo-HSCT 8 are often inaccessible. In some cases, sponsored programs from the pharmaceutical industry fund these therapies, providing a short-term solution to access.…”

Section: Resultsmentioning

confidence: 99%

“…There is a wide variation in transplant rates in the region, mostly related to GDP. Limited access to MoAbs, allo-HSCT, 8 and CAR-T-cell therapy occurs in LA. These therapies also require specialized centers with trained personnel and regulatory approval.…”

Section: Treatment Recommendationsmentioning

confidence: 99%

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Expert Recommendations for the Diagnosis, Treatment, and Management of Adult B-Cell Acute Lymphoblastic Leukemia in Latin America

Basquiera

Seiwald

Aguilera

et al. 2023

JCO Global Oncology

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PURPOSE Despite strong induction chemotherapy response rates, only 30%-40% of patients with adult B-cell acute lymphoblastic leukemia (ALL) attain long-term remission. This study analyzes ALL in Latin America (LA) and recommends diagnosis, treatment, and management protocols. METHODS The Americas Health Foundation organized a panel of hematologists from Argentina, Brazil, Chile, Colombia, and Mexico to examine ALL diagnosis and therapy and produce recommendations. RESULTS Lack of regional data, unequal access to diagnosis and therapy, inadequate treatment response, and uneven health care distribution complicate adult ALL management. The panel recommended diagnosis, first-line and refractory treatment, and post-transplantation maintenance. Targeted treatments, including rituximab, blinatumomab, and inotuzumab ozogamicin, are becoming available in LA and must be equitably accessed. CONCLUSION This review adapts global information on treating ALL to LA. Governments, the medical community, society, academia, industry, and patient advocates must work together to improve policies.

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“…The underlying cause for this is unknown although several hypotheses exist, including socioeconomic disparities, environmental risks, and genetic variants. 3 , 5 - 8 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Expert Recommendations for the Diagnosis, Treatment, and Management of Adult B-Cell Acute Lymphoblastic Leukemia in Latin America

Basquiera

Seiwald

Aguilera

et al. 2023

JCO Global Oncology

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“…Unfortunately, there are limited data available regarding the turnaround time for BCR-ABL1 testing in LMICs. Performing routine genetic testing for acute leukemia can pose challenges in certain healthcare centers [16,20,21]. A delayed detection of the Philadelphia chromosome can result in patients receiving general induction remission protocols without TKIs, and, regrettably, more intensive treatments than necessary for this patient population.…”

Section: Diagnostic Barriers In Lmicmentioning

confidence: 99%

“…Moreover, current trial designs and the rarity of the disease might also delay approval by regulatory agencies. Indeed, few prospective reports in Ph+ ALL have substantiated treatment in LMIC, even though adaptations are sometimes employed to improve results [13,16].…”

Section: Introductionmentioning

confidence: 99%

How to Manage Philadelphia-Positive Acute Lymphoblastic Leukemia in Resource-Constrained Settings

Silva,

Rego

2023

Cancers

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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.

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Clinical significance of Philadelphia‐like‐related genes in a resource‐constrained setting of adult B‐acute lymphoblastic leukemia patients

Lima,

Rojas,

Nogueira

et al. 2024

eJHaem

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Adult acute lymphoblastic leukemia in a resource-constrained setting: outcomes after expansion of genetic evaluation

Cited by 7 publications

References 42 publications

Expert Recommendations for the Diagnosis, Treatment, and Management of Adult B-Cell Acute Lymphoblastic Leukemia in Latin America

Expert Recommendations for the Diagnosis, Treatment, and Management of Adult B-Cell Acute Lymphoblastic Leukemia in Latin America

How to Manage Philadelphia-Positive Acute Lymphoblastic Leukemia in Resource-Constrained Settings

Clinical significance of Philadelphia‐like‐related genes in a resource‐constrained setting of adult B‐acute lymphoblastic leukemia patients

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