Diagnosis, prognosis and novel therapy for Ph-like ALL in Canada

While cure rates for childhood acute lymphoblastic leukemia (ALL) have improved significantly in the current era, relapse remains the most common cause of treatment failure and death. Teenagers and young adults with ALL have a worse outcome compared to younger children. Advances in cancer genetics have recently made several important discoveries, such as the identification of a particular group of patients who display a 'genetic signature' similar to that of Philadelphia (Ph) chromosome-positive ALL but lacking the Ph chromosome. This is known as Ph-like ALL, and comprises approximately 15% of childhood ALL and over 25% among adults with ALL. Despite modern chemotherapy regimens, this group has poor survival rates compared to those without the 'Ph-like' signature. Testing for Ph-like ALL remains limited in Canada and about 500 ALL patients do not have access to such testing each year. Given the poor prognosis and the possibility for outcome improvement, the main goal of this study is to develop a national screening program for Ph-like ALL using a novel sequencing technology. This screening will allow to identify Ph-like ALL patients who could benefit from the addition of TKI in combination with conventional chemotherapy in order to improve their outcomes.