Targeted therapy: The new lease on life for acute promyelocytic leukemia, and beyond

IUBMB Life. 2012 Aug;64(8):671-5. doi: 10.1002/iub.1055. Epub 2012 Jun 19.

Abstract

Leukemia, a group of hematological malignancies characterized by abnormal proliferation, decreased apoptosis, and blocked differentiation of hematopoietic stem/progenitor cells, is a disease involving dynamic change in the genome. Chromosomal translocation and point mutation are the major mechanisms in leukemia, which lead to production of oncogenes with dominant gain of function and tumor suppressor genes with recessive loss of function. Targeted therapy refers to treatment strategies perturbing the molecules critical for leukemia pathogenesis. The t(15;17) which generates PML-RARα, t(8;21) that produces AML1-ETO, and t(9;22) which generates BCR-ABL are the three most frequently seen chromosomal translocations in myeloid leukemia. The past two to three decades have witnessed tremendous success in development of targeted therapies for acute and chronic myeloid leukemia caused by the three fusion proteins. Here, we review the therapeutic efficacies and the mechanisms of action of targeted therapies for myeloid leukemia and show how this strategy significantly improve the clinical outcome of patients and even turn acute promyelocytic leukemia from highly fatal to highly curable.

Publication types

  • Review

MeSH terms

  • Antineoplastic Agents / therapeutic use*
  • Arsenic Trioxide
  • Arsenicals / therapeutic use*
  • Core Binding Factor Alpha 2 Subunit / genetics
  • Core Binding Factor Alpha 2 Subunit / metabolism
  • Fusion Proteins, bcr-abl / genetics
  • Fusion Proteins, bcr-abl / metabolism
  • Hematopoietic Stem Cells / cytology
  • Hematopoietic Stem Cells / drug effects
  • Hematopoietic Stem Cells / pathology
  • Humans
  • Leukemia, Promyelocytic, Acute / drug therapy*
  • Leukemia, Promyelocytic, Acute / genetics
  • Leukemia, Promyelocytic, Acute / metabolism
  • Molecular Targeted Therapy / methods*
  • Oncogene Proteins, Fusion / genetics
  • Oncogene Proteins, Fusion / metabolism
  • Oxides / therapeutic use*
  • RUNX1 Translocation Partner 1 Protein
  • Translocation, Genetic / drug effects
  • Tretinoin / therapeutic use*
  • Tumor Cells, Cultured

Substances

  • AML1-ETO fusion protein, human
  • Antineoplastic Agents
  • Arsenicals
  • Core Binding Factor Alpha 2 Subunit
  • Oncogene Proteins, Fusion
  • Oxides
  • RUNX1 Translocation Partner 1 Protein
  • promyelocytic leukemia-retinoic acid receptor alpha fusion oncoprotein
  • Tretinoin
  • Fusion Proteins, bcr-abl
  • Arsenic Trioxide