New monoclonal antibodies for the treatment of acute lymphoblastic leukemia

• Monoclonal antibodies represent a major advance in the treatment of ALL.
• New antibody constructs are showing exciting results in relapsed/refractory ALL.
• Incorporation of the new antibody constructs into initial therapy is eagerly awaited.

Monoclonal antibodies represent a major advance in treatment of acute lymphoblastic leukemia (ALL). Targeted delivery of these agents based on leukemic cell-surface receptor recognition, improves efficacy and minimizes off-target toxicity. The antigens CD19, CD20, CD22 and CD52, are the most common antigens to which monoclonal antibodies in B-cell ALL have been directed. Rituximab, an anti-CD20 antibody, in combination with conventional chemotherapy has been shown to improve survival in newly diagnosed CD20 positive B-cell ALL. Blinatumomab, a bispecific T-cell engager, as monotherapy in relapsed and refractory B-cell ALL resulted in prolonged relapse free survival. Inotuzumab ozogamicin, an anti-CD22 antibody, alone and in combination with chemotherapy has been promising in relapsed and refractory B-cell ALL. The effectiveness and safety of several newer monoclonal antibodies including ofatumumab, obinutuzumab, epratuzumab, denintuzumab mafodotin and moxetumomab pasudotox as single agents or in combination with a chemotherapeutic back bone are currently under investigation.