Replase in Pediatric Acute Lymphoblastic Leukemia: Clinical and Biological Perspectives in Baghdad Hospital

Abstract

Relapsed acute lymphoblastic leukemia (ALL) is a clinical challenge despite the improvements in survival with conventional chemotherapy regimens. Herein, we aimed to assess the role of novel therapeutic approaches, such as immunotherapy and targeted therapy for children who were diagnosed with relapsed ALL in pediatric hospitals of Baghdad city/Iraq. We performed a prospective observational study on pediatric patients with ALL relapse. The patients were managed with conventional chemotherapy protocols or immunotherapy (blinatumomab) or chimeric antigen receptor T-cell (CAR-T) therapy. The rates of remission and minimal residual disease (MRD), overall survival (OS) and treatment toxicity were assessed among groups. Our results revealed significantly higher rate of remission among patients who received CAR-T cell therapy compared to conventional chemotherapy and immunotherapy groups. Blinatumomab elicited better MRD-negative complete response with less toxicity. Combination of novel therapies improved treatment outcomes significantly. Our study recommended adding novel immunotherapies to the management plan of pediatric relapsed ALL in Iraq.