{{Acute Lymphoblastic Leukemia}}

Last updated Dec 14, 2022 Edit Source

• Diseases
• Blood cancers
• Lymphoid

2022-07-26 Kate Baker intro 2022-08-03 Vivek Patel mgmt

• PB flow: MPO -ve, TDT+, look for CD19, CD20, CD22 (see tx below)

• BMBx, excisional LN bx

• cyto (e.g. if Ph+ may add TKI)

• PCR: typically BCR-ABL p190, can also have p210, p230

  • order p190, p210
  • p190 typically acute (shorter)
  • p210 typically chronic

• CNS eval and tx

• JCO 2010 MD Anderson study on Ritux: used % positivity of CD20 (>20%) as inclusion, in practice no % positivity is reported out

• add targeted therapies based on findings

  • e.g. CD20+ -> rituximab, Ph+ -> TKI
  • my first ALL pt had Ph+, CD20+, so got R-HyperCVAD/MA+TKI

• CD19: blinutumomab, CAR-T
• CD20: rituximab
• CD22: inotuzumab ozogamicin
• if age <40: (R)HyperCVAD/MA(+TKI) -> cure ~50% if able to tolerate tx, MRD -ve after first induction
• blinutumomab, inotuzumab viewed as bridge to transplant, used in salvage
• if targeted therapy available (e.g. dasatinib), typically add back targeted agent s/p SCT at D+101.
  • BiTE/CAR-T recommended against s/p SCT unless major relapse, as likelihood of clinically significant GVHD is worrisome.
• Kantarjian, Lancet Onc 2018, pII MD Anderson: >60, Ph-, hyper-mini-CVD + inotuzumab. Not a comparative study. In practice, inotuzumab has significant hepatotoxicity, etc,. so often skipped or used in a reduced fashion.