The cure of leukemia through the optimist's prism

• Published in: Cancer 2022-01, Vol.128 (2), p.240-259
• Main Authors: Kantarjian, Hagop M., Jain, Nitin, Garcia‐Manero, Guillermo, Welch, Mary Alma, Ravandi, Farhad, Wierda, William G., Jabbour, Elias J.
• Format: Article
• Language: English
• Subjects: Acute lymphoblastic leukemia; Acute myeloid leukemia; Acute promyeloid leukemia; Antibodies; Antineoplastic Combined Chemotherapy Protocols; Arsenic; Arsenic trioxide; CD19 antigen; CD20 antigen; CD22 antigen; Chemotherapy; Chronic lymphocytic leukemia; Chronic myeloid leukemia; Cladribine; Cytarabine; Fludarabine; Fusion Proteins, bcr-abl; Gemtuzumab; Gemtuzumab ozogamicin; Hairy cell leukemia; Humans; Inhibitors; Kinases; Leukemia; Leukemia, Myeloid, Acute - drug therapy; Lymphatic leukemia; Medical prognosis; Myelodysplastic syndrome; Myelodysplastic syndromes; Oncology; Philadelphia chromosome; prognosis; progress; Promyeloid leukemia; Protein Kinase Inhibitors; Protein-tyrosine kinase; Retinoic acid; Rituximab; Survival; therapy; Tyrosine; updates
• ISSN: 0008-543X; 1097-0142; 1097-0142
• DOI: 10.1002/cncr.33933

Progress is occurring at a dizzying rate across all leukemias. Since the authors' review of the topic in Cancer in 2018, numerous discoveries have been made that have improved the therapy and outcomes of several leukemia subsets. Hairy cell leukemia is potentially curable with a single course of cladribine followed by rituximab (10‐year survival, ≥90%). Acute promyelocytic leukemia is curable at a rate of 80% to 90% with a nonchemotherapy regimen of all‐trans retinoic acid and arsenic trioxide. The cure rate for core‐binding factor acute myeloid leukemia (AML) is ≥75% with fludarabine, high‐dose cytarabine, and gemtuzumab ozogamicin. Survival for patients with chronic myeloid leukemia is close to that for an age‐matched normal population with BCR‐ABL1 tyrosine kinase inhibitors (TKIs). Chronic lymphocytic leukemia, a previously incurable disease, may now be potentially curable with a finite duration of therapy with Bruton tyrosine kinase inhibitors and venetoclax. The estimated 5‐year survival rate for patients with Philadelphia chromosome–positive acute lymphoblastic leukemia (ALL) exceeds 70% with intensive chemotherapy and ponatinib, a third‐generation BCR‐ABL1 TKI, and more recent nonchemotherapy regimens using dasatinib or ponatinib with blinatumomab are producing outstanding results. Survival in both younger and older patients with ALL has improved with the addition of antibodies targeting CD20, CD19 (blinatumomab), and CD22 (inotuzumab) to chemotherapy. Several recent drug discoveries (venetoclax, FLT3 and IDH inhibitors, and oral hypomethylating agents) are also improving outcomes for younger and older patients with AML and for those with higher risk myelodysplastic syndrome. Major progress is occurring at a very rapid pace in leukemia. This review summarizes the important recent discoveries in these disorders.