Abstract
Acute lymphoblastic leukaemia (ALL) is a haematological malignancy characterized by the uncontrolled proliferation of immature lymphoid cells. Over past decades, significant progress has been made in understanding the biology of ALL, resulting in remarkable improvements in its diagnosis, treatment and monitoring. Since the advent of chemotherapy, ALL has been the platform to test for innovative approaches applicable to cancer in general. For example, the advent of omics medicine has led to a deeper understanding of the molecular and genetic features that underpin ALL. Innovations in genomic profiling techniques have identified specific genetic alterations and mutations that drive ALL, inspiring new therapies. Targeted agents, such as tyrosine kinase inhibitors and immunotherapies, have shown promising results in subgroups of patients while minimizing adverse effects. Furthermore, the development of chimeric antigen receptor T cell therapy represents a breakthrough in ALL treatment, resulting in remarkable responses and potential long-term remissions. Advances are not limited to treatment modalities alone. Measurable residual disease monitoring and ex vivo drug response profiling screening have provided earlier detection of disease relapse and identification of exceptional responders, enabling clinicians to adjust treatment strategies for individual patients. Decades of supportive and prophylactic care have improved the management of treatment-related complications, enhancing the quality of life for patients with ALL.
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Acknowledgements
The authors acknowledge anyone who faced or faces a diagnosis of ALL. You did not suffer in vain. Your voices were heard. Your lives mattered more than you may know. You will always be remembered by the families who supported you, your friends who stood by your side and the health-care teams who cured when they could, healed when they could not, and try to comfort always; yesterday, today and tomorrow.
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Introduction (G.R. and L.P.); Epidemiology (G.R. and L.P.); Mechanisms/pathophysiology (G.R., C.G.M., S.-J.C., D.H., M.Z. and Z.C.); Diagnosis, screening and prevention (G.R., C.M., C.J.H. and L.P.); Management (G.R., S.S.W. and N.B.); Quality of life (G.R. and S.S.W.); Outlook (G.R. and S.S.W.).
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C.G.M. has received research funding from Pfizer and AbbVie, has stock in Amgen, and is on an advisory board for Illumina.
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Nature Reviews Disease Primers thanks T. Szczepański; D. Sinnett; V. Conter; I. Aldoss, who co-reviewed with S. Forman; and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.
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Pagliaro, L., Chen, SJ., Herranz, D. et al. Acute lymphoblastic leukaemia. Nat Rev Dis Primers 10, 41 (2024). https://doi.org/10.1038/s41572-024-00525-x
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DOI: https://doi.org/10.1038/s41572-024-00525-x
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