Treatment of patients with acute lymphoblastic leukemia who are not suitable for high-dose chemotherapy and hematopoietic stem cell transplantation

Abstract

Introduction. Acute lymphoblastic leukemia is a malignant disease characterized by the proliferation of precursor B-cells, Tcells or less often, precursors of NK-cells. B-cell acute lymphoblastic leukemia is more common in patients >60 years of age compared to patients <60 years of age (89% vs. 66%), and cytogenetic abnormalities such as t(9;22) (Ph+) are more common in older than younger patients (36% against 19%). Elderly patients often have a poor status and comorbidities, so poor disease outcome is more common. Clinical and biological features. B cell acute lymphoblastic leukemia is more common in patients >60 years of age compared to patients <60 years of age (89% vs 66%) and cytogenetic abnormalities such as t(9;22) are more common in older vs. younger (36% vs. 19%). Therapy. The elderly and patients with comorbidities require less intensive therapy, based on corticosteroids, vincristine and asparaginase, while avoiding anthracyclines and alkylating agents, due to the high mortality associated with treatment. For ?unfit? patients with Ph-positive acute lymphoblastic leukemia, tyrosine kinase inhibitors with reduced-intensity chemotherapy or corticosteroids alone are recommended. For t(9;22) negative patients, low-dose corticosteroid chemotherapy with or without immunotherapy is recommended. For patients with T-cell acute lymphoblastic leukemia, chemotherapy with venetoclax may be an option. Conclusion. The introduction of targeted therapy has changed treatment options in acute lymphoblastic leukemia. For elderly patients, targeted therapy is a necessary modality since standard chemotherapy leads to a poor outcome due to its toxicity and ineffectiveness.