Published On: 26th March, 2024
ABSTRACT
Leukaemia treatment has entered a new era with personalized medicine by tailoring therapies to individual patients based on their molecular profiles and unique genetics. Personalized medicine offers targeted therapies that offer improved efficacy and reduced side effects. Through precise analysis of genetic mutations and molecular signatures treatment approaches become carefully adjusted, optimizing therapeutic outcomes. Advanced diagnostic tools like Next-generation sequencing enable accurate disease classification which guides personalized treatment decisions. Even though there are challenges, Personalized medicine gives us hope in leukemia care by promising better outcomes for patients. This review highlights the impact of personalized medicine in leukemia treatment and the advancing personalized treatment approaches.
KEYWORDS:
Leukaemia, Personalised Medicine, Targeted therapies, Immunotherapy
INTRODUCTION
In the body blood cells are made through a regulated process called hematopoiesis but when there are genetic mistakes like chromosomal abnormalities or mutations it can lead to leukaemia where immature cells multiply uncontrollably. Leukaemia and lymphomas are cancers that develop from these faulty cells each with its characteristics based on the type and stage of cell growth [1]. Personalized medicine is an evolving strategy in disease management and prevention that considers the unique genetic, environmental, and lifestyle factors of each individual. Unlike uniform treatment approaches, personalized medicine enables healthcare professionals and researchers to more precisely anticipate the effectiveness of specific treatments and preventive measures tailored to individual patients [2].In acute myeloid leukemia (AML) precision medicine is advancing through targeted therapies like FLT3 and IDH inhibitors. Next-generation sequencing helps refine risk assessment and treatment decisions. In lymphoid cancers especially in chronic lymphocytic leukemia (CLL) knowing about TP53 mutations helps guide treatment and in Diffuse large B-cell lymphoma (DLBCL) distinct genetic profiles are beginning to influence treatment decisions[3]. Personalized immunotherapy is revolutionizing chronic lymphocytic leukemia (CLL) treatment by tailoring therapies to address immune system deficiencies. Recent advances including combinations of targeted drugs like ibrutinib and Bcl-2 inhibitors along with anti-CD20 monoclonal antibodies showed promising outcomes[4].
LITERATURE REVIEW
Rise of Personalised Medicine
Conventional chemotherapy in cancer treatment administers drugs intravenously to halt cell division achieving significant cure rates in acute leukemia and lymphomas. However, its non-specific targeting causes toxic effects in healthy tissues often leading to treatment discontinuation[5]. Personalized medicine in AML focuses on targeting leukemic stem cells (LSCs) which persist despite conventional chemotherapy by exploiting their distinct metabolic vulnerabilities. Precision therapies offer promising strategies to selectively eradicate LSCs and improve treatment outcomes in AML[6]. The development of FLT3 inhibitors has transformed AML treatment but questions persist regarding their efficacy in frontline therapy and maintenance post- hematopoietic stem cell transplantation while ongoing research explores their potential in combination therapies and AML patients without FLT3 mutations[7].
Biomarker of Leukaemia and Targeted Therapies
Precision medicine employs biomarkers like BCR-ABL1, MLL rearrangements, and purine nucleoside phosphorylase mutations to tailor treatments, while biomarkers for immunotherapy include CD19 and CD22 for CAR-T cell therapy in pediatric B-cell acute lymphoblastic leukemia[8]. TP53 mutations pose challenges in AML therapy prompting the exploration of strategies like APR-246 and HSP90 inhibitors to restore or degrade mutant TP53 which paves the way for targeted treatments. Overexpression of genes like BAALC and MN1 serves as prognostic markers that influence treatment response and outcomes[9]. Targeted treatment with tyrosine kinase inhibitors (TKIs) has transformed chronic myeloid leukemia (CML) management and significantly improved patient survival by inhibiting the BCR-ABL1 oncoprotein. Despite this progress, TKI resistance remains a challenge necessitating the exploration of alternative therapeutic strategies[10]. In recent years CAR-T cell therapies have revolutionized immunotherapy for haematological malignancies with FDA approval for B cell malignancies. Ongoing advancements including novel targets and bioengineering approaches hold promise for expanding CAR-T therapy to treat solid tumors [11].
Diagnostic Techniques in Personalized Medicine
Advancements in diagnostic techniques have revolutionized the field of personalized medicine such as NGS-driven characterization of the genetic landscape in leukemia specifically AML transforms diagnosis and therapy enabling tailored treatment strategies by targeting specific genetic lesions like FLT3 mutations or CD33 positivity.[12] In a study (La Starza et al., 2020) researchers aimed to develop a comprehensive diagnostic tool CI-FISH to investigate genetic abnormalities in T-cell acute lymphoblastic leukemia (T-ALL) patients. This assay simultaneously assesses recurrent chromosome rearrangements involving oncogenes and tumor suppressors implicated in T-ALL pathogenesis. By applying CI-FISH to 338 T-ALL cases, the study achieved genetic classification into well-defined subgroups in 80% of cases highlighting its efficacy in detecting actionable biomarkers[13].In another study (Ansuinelli, M et al., 2021) they demonstrated the utility of ddPCR in refining MRD evaluation for adult Ph+ ALL cases potentially reducing the proportion of non-quantifiable samples compared to Q-RT-PCR and improving prognosis. Additionally, ddPCR offers promise for detecting detrimental mutations like T315I, enhancing clinical management and treatment decisions for Ph+ (Philadelphia chromosome-positive)ALL patients[14].
Challenges and Future Perspectives
The evolution of precision medicine in cancer treatment has been significant starting from the use of antioestrogen in breast cancer to the identification of predictive biomarkers and targeted therapies. With expanding genetic knowledge interpreting molecular tumor profiles is crucial for optimal treatment [14]. Personalized medicine also faces challenges in implementation due to ethical concerns regarding data privacy and algorithmic biases by models [15]. Recent advancements in acute leukemia treatment including novel therapies and improved transplantation techniques have led to overall improved survival rates. However, persistent racial, ethnic, and socioeconomic disparities in access to these treatments highlight the urgent need for equitable distribution of precision medicine[16].
CONCLUSION
In conclusion, personalized medicine has opened the doors to a new chapter in leukaemia treatment fundamentally reshaping how we care for patients. While significant strides have been made challenges persist including equal access to personalized treatments and the ethical implications of genomic data use. Nevertheless, the future of personalized medicine in leukemia is promising with ongoing research and technological advancements positioned to further enhance treatment outcomes. As researchers continue to refine our understanding of leukemia biology and individual patient characteristics personalized medicine holds immense potential to transform the lives of leukemia patients offering hope for a future where treatment is not only effective but also tailored to the unique needs of each individual.
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