Abstract 6481: Systematic review of the literature: tertiary prevention in leukemia patients
Authors: Manyak Nikita , Jung Su Yon 
Published: June 2023

Abstract
Background: After conducting a thorough search, we found a lack of published literature review about the tertiary prevention of patients with leukemias and discussion about their prognosis. We thus searched related publications in the last decade and wrote an extensive literature review on the topic.
Method: We conducted an extensive search for electronic database via MEDLINE and PubMed. Using the key terms “progression-free survival (PFS) leukemia” and restricting the search to “English language” for the last decade, we initially found 1,083 published papers on the related topic. On the basis of review, we collected necessary data and extracted some recommendations for treatment of leukemia patients.
Results: Standard treatments such as Daunorubicin, Doxorubicin, or Asparaginase for leukemias in children, adolescents, and young adults (ages 18 to 24) were associated with high rates of relapse and other complications within 5 years post-treatment. Of note, Blinatumomab and Ibrutinib-Rituximab showed higher success rates of PFS and overall survival compared to other chemotherapy treatments. Two-year disease free survival was 39.0% for patients with intensive chemotherapy while it was 54.4% for patients given the anticancer drugs. In addition, two-year overall survival was relatively worse (58.4%) in patients treated with chemotherapy compared with those with other treatments (71.3%). In comparison, radiotherapy has been used for patients who relapsed after remission and found to be more successful in the long run in preventing another relapse and leading to higher rates of overall survival. For example, patients previously experienced a 78% response rate to the treatment received cranial radiation; compared to the survival rate (11.3%) of patients who were not treated with the radiation, they experienced higher four-year survival rates (77.7%). For most pediatric leukemias, allogenic stem cell therapies have been the most effective treatment with a higher rate of remission. However, after this treatment, a majority of the patients relapsed soon after and were unable to continue fighting the disease, resulting in death. Of note, during the past 10 years, some immunotherapies have been discovered and reported more effective than traditional chemo/radiotherapies and allogenic/autologous stem cell treatments. In particular, Tisagenlecleucel, a chimeric antigen receptor (CAR) T-cell therapy, has been approved to treat pediatric leukemias when they have relapsed after initial or tertiary remission. Their 5 or 10 year survival rate after this treatment was over 50%.
Conclusion: Among the standard treatments that have been studied during a decade for leukemia in children and adolescents, CAR T-cell immunotherapy appears to be the most effective after patient relapse. More research for the immunotherapies on different populations with diverse age groups is requested on a tertiary prevention perspective.
Citation Format: Nikita Manyak, Su Yon Jung. Systematic review of the literature: tertiary prevention in leukemia patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6481.