VIDEO: Understanding the molecular and genetic basis of ALL

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So, ALL, or acute lymphoblastic leukemia, has, you know, historically been thought of as a disease with major subtypes, including B-cell and T-cell ALL, and then the so-called Philadelphia chromosome-positive and Philadelphia chromosome-negative ALL. I think the major advances particularly have been recognition for the pH-negative group of patients — the incredible genetic diversity of this subgroup.

Advances in the lab from colleagues who do molecular genetics research have really begun to define a lot more subtypes of this group, and for many of these subgroups, the genetic basis of the ALL can help identify particular treatment approaches, whether that’s a targeted agent or information that predicts prognosis that may allow the treatment to be escalated or deescalated.

So, the most important thing for individuals treating patients with ALL is to really make sure that their patients are evaluated at a center capable of sending a range of genetic tests, including conventional chromosomes and karyotype, but also a range of molecular tests including next-generation sequencing and a panel that allows the detection of some so-called fusion proteins so that the most information can be gleaned possible, including particular abnormalities that help identify the so-called pH-like, or Philadelphia chromosome-like, ALL. Many of those patients may benefit from tyrosine kinase inhibitors and particular targeted treatment approaches.