Onkológia 5/2025
Treatment of the B-cell acute lymphoblastic leukemia
Purpose: B-cell acute lymphoblastic leukemia (B-ALL) is initially treated for 5-7 days with a so-called prephase consisting of corticosteroids, usually dexamethasone +/- cyclophosphamide, with the aim of reducing the tumor mass followed by induction chemotherapy. Treatment protocols vary between countries but basically the following drugs are used: anthracycline, vincristine, dexamethasone, asparaginase, methotrexate, cyclophosphamide, cytosine-arabinoside, mercaptopurine. Patients with B-ALL after induction therapy achieve very good therapeutic responses, up to 90% of them achieve hematological remission of the disease, only 5-7% are refractory, and the remaining 3-5% counts for induction mortality - death during treatment.
Case: We use case report to explain how to proceed if hematological remission of the disease is not achieved after induction therapy.
Conclusion: chemoresistant B-ALL represents a clear indication for the use of CAR T-cell therapy, and it is most effective to use inotuzumab ozogamicin for bridging, and to perform allogeneic hematopoietic stem cell transplantation after hematological remission is achieved in the prevention of relapse. It is not appropriate to use blinatumomab for bridging prior to CAR T-treatment because both treatment modalities have the same therapeutic target - CD19 antigen on the surface of tumor cells.
Keywords: B-cell acute lymphoblastic leukemia, hematological remission, treatment
