Is Acute Lymphoblastic Leukemia the Same in Every Patient?

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Andrew Schorr:

This continues to be an evolving field as you get to do very sophisticated testing increasingly to understand what's going on for a patient with this diagnosis.  So what do we know now?  Is ALL the same in every patient? 

Dr. Cassaday:

No, in a word.  There's a few different ways that we can segregate cases of ALL into different categories, so what's been known for a while, there's two different lineages of ALL.  There's B‑cell and T‑cell ALL, which don't necessarily change a lot in terms of frontline treatment but that are really important in terms of second‑line therapies, at least currently. 

And then going even deeper into the sort of genomic and generic level there are‑‑another key distinction is the Philadelphia chromosome, the BCR‑ABL translocation, which is more commonly associated with CML but is also really important in ALL.  But depending on the age range anywhere from 5 to 50 percent of patients with ALL will have that genetic abnormality.  That's really important in terms of deciding treatment and prognosis. 

Up until maybe five‑ish, 10 years ago maybe that was kind of the key distinction really in terms of making treatment decisions, but it's gotten a lot more sophisticated recently with increased understanding of other genetic pathways that are important that might predict response to treatment, might confer a certain prognosis. 

Andrew Schorr:

So we just want to explain to our audience, and, many people, this is all new and terrifying.  So when we're talking about genes, it's not what color your eyes are, what color your hair is.  These are part of your makeup, but it's cancer genes, genes that have gone awry, and you're trying, like with the Philadelphia chromosome is there a pill sometimes that can fix it. 

Dr. Cassaday:

Right. 

Andrew Schorr:

Do you need other kind of treatments, which I know have ranged from stem cell transplant to chemotherapy to now these targeted therapies, monoclonal antibodies and delivered in different ways?  So just to give people hope, it sounds like you have more approaches, both approved and some investigational than ever before. 

Dr. Cassaday:

That's true.  With the evolving understanding of the sort of genetics and molecular pathways that are important in ALL, some of these new pathways in ALL we're starting to understand more about how we could potentially block certain important signals that could be kind of drivers of the cancer.  So if we can find a particular target to block with a pill that's designed specifically to block a signal in the leukemia cell, that could potentially have a really important impact therapeutically. 

And you're absolutely right.  Genes that we talk about in this disease are not genes that you inherited in a defective manner from your parents or that you could pass along to your children.  These are genes that get mutated or become abnormal in the context of developing the ALL, so they're very specific and unique to the malignant cells. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.