My name is Doctor Mark Litzow. I am a hematologist at the Mayo Clinic in Rochester, Minnesota. I'd like to talk with you a little bit today about the major advances that we're making in the treatment of acute lymphoblastic leukemia.
There are two types of acute lymphoblastic leukemia, and that's based on the cells that they arise from. There are some cells in our blood, in our immune system, called lymphocytes. There are some that are B-cells, and these cells can sometimes turn into leukemia. There's also T cells that come from cells called thymocytes, and sometimes you can have a T cell ALL. That one is less common.
We've actually made the most advances in the treatment of B-cell acute lymphoblastic leukemia, or ALL. This has been based on immune therapy—making use of the immune system to attack the leukemia cells. There are some proteins in our blood called antibodies. We can make antibodies in the lab that react against cells. There are several different types of what we call monoclonal antibodies that react against leukemia cells.
The first one was rituximab, which reacts against a protein on the cell named CD20. More recently, CD19, which is on virtually all B cells, has become a target. We have medications that can react against CD19 and kill the leukemia cells. One such agent is blinatumomab, which brings a normal T-cell close to the leukemia cell and kills it.
There are also some medications that are antibodies where we've attached a drug to it. The antibody delivers a drug to the leukemia cell so that it can kill it, with fewer side effects. One such agent is called inotuzumab. We have now done studies combining some of these antibody treatments with chemotherapy and shown that we can improve the survival and outcome with the use of these agents.
What we think we can do now—and are planning, with some studies already underway—is to use more of these immunotherapy approaches in order to lessen the amount of chemotherapy that we're giving and reduce some of the side effects related to chemotherapy.
Another big immunotherapy is what we call CAR-T cells. These are chimeric antigen receptor T cells. We've actually put an antibody inside the T cell that sits on the surface of the T cell so it can bring the T cell even closer to the leukemia cells and help kill them. CAR-T cells are being used in multiple different blood cancers, including multiple myeloma and lymphoma.
Here, I’m talking about acute lymphoblastic leukemia, which is one of the first areas where CAR-T cells were utilized. It’s also utilized in a chronic form called chronic lymphocytic leukemia. CAR-T cells have been very helpful in the treatment of acute lymphoblastic leukemia. They've mostly been used in situations where the leukemia, unfortunately, has come back after treatment. But we're now thinking that we can move CAR-T cells earlier into the treatment in order to help improve survival and outcomes.
We’re quite encouraged by these results and think it's going to help cure more patients of their ALL. In T cell ALL, we haven't made as many advances, but CAR-T cells are also starting to have a role in that disease. There are also some new agents that are looking to be beneficial in T-cell ALL. So we hope that we'll make some of the same progress in that subtype of ALL that we've made in the B cell subtype of ALL.
We’re quite encouraged about the future, and I think it's a bright one. We're going to make further advances.
HealthTree • June 30, 2025