Progress is occurring at a dizzying rate across all
leukemias. Since the authors' review of the topic in
Cancer in 2018, numerous discoveries have been made that have improved the
therapy and outcomes of several
leukemia subsets.
Hairy cell leukemia is potentially curable with a single course of
cladribine followed by
rituximab (10-year survival, ≥90%).
Acute promyelocytic leukemia is curable at a rate of 80% to 90% with a nonchemotherapy regimen of
all-trans retinoic acid and
arsenic trioxide. The cure rate for
core-binding factor acute myeloid leukemia (AML) is ≥75% with
fludarabine, high-dose
cytarabine, and
gemtuzumab ozogamicin. Survival for patients with
chronic myeloid leukemia is close to that for an age-matched normal population with BCR-ABL1
tyrosine kinase inhibitors (TKIs).
Chronic lymphocytic leukemia, a previously incurable disease, may now be potentially curable with a finite
duration of therapy with
Bruton tyrosine kinase inhibitors and
venetoclax. The estimated 5-year survival rate for patients with
Philadelphia chromosome-positive
acute lymphoblastic leukemia (ALL) exceeds 70% with intensive
chemotherapy and
ponatinib, a third-generation BCR-ABL1 TKI, and more recent nonchemotherapy regimens using
dasatinib or
ponatinib with
blinatumomab are producing outstanding results. Survival in both younger and older patients with ALL has improved with the addition of
antibodies targeting CD20, CD19 (
blinatumomab), and CD22 (inotuzumab) to
chemotherapy. Several recent drug discoveries (
venetoclax, FLT3 and IDH inhibitors, and oral hypomethylating agents) are also improving outcomes for younger and older patients with AML and for those with higher risk
myelodysplastic syndrome.