New biomarkers and therapeutic strategies in acute lymphoblastic leukemias: recent advances

Acute lymphoblastic leukemia (ALL) represents a heterogeneous group of hematologic malignancies and it is normally characterized by an aberrant proliferation of immature lymphoid cells. Moreover, dysregulation of multiple signaling pathways that normally regulate cellular transcription, growth, translation and proliferation, is frequently encountered in this malignancy. ALL is the most frequent tumor in childhood, and adult ALL patients still correlate with poor survival. This review focuses on modern therapies in ALL that move beyond standard chemotherapy, with a particular emphasis on immunotherapeutic approaches as new treatment strategies. BiTE antibodies, the chimeric antigen receptor (CAR)-T cells or CRISPR-Cas9 (clustered regularly interspaced short palindromic repeats-CRISPR associated nuclease 9) represent other new innovative approaches for this disease. Target and tailored therapy could make the difference in previously untreatable cases, i.e. precision and personalized medicine. Clinical trials will help to select the most efficient novel therapies in ALL management, and to integrate them with existing treatments to achieve durable cures.