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Strategies to Overcome Resistance Mechanisms in T-Cell Acute Lymphoblastic Leukemia

Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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Int. J. Mol. Sci. 2019, 20(12), 3021; https://doi.org/10.3390/ijms20123021
Received: 18 May 2019 / Revised: 14 June 2019 / Accepted: 17 June 2019 / Published: 20 June 2019
(This article belongs to the Special Issue Drug Resistance in Hematologic Malignancies)
Chemoresistance is a major cause of recurrence and death from T-cell acute lymphoblastic leukemia (T-ALL), both in adult and pediatric patients. In the majority of cases, drug-resistant disease is treated by selecting a combination of other drugs, without understanding the molecular mechanisms by which malignant cells escape chemotherapeutic treatments, even though a more detailed genomic characterization and the identification of actionable disease targets may enable informed decision of new agents to improve patient outcomes. In this work, we describe pathways of resistance to common chemotherapeutic agents including glucocorticoids and review the resistance mechanisms to targeted therapy such as IL7R, PI3K-AKT-mTOR, NOTCH1, BRD4/MYC, Cyclin D3: CDK4/CDK6, BCL2 inhibitors, and selective inhibitors of nuclear export (SINE). Finally, to overcome the limitations of the current trial-and-error method, we summarize the experiences of anti-cancer drug sensitivity resistance profiling (DSRP) approaches as a rapid and relevant strategy to infer drug activity and provide functional information to assist clinical decision one patient at a time. View Full-Text
Keywords: T-ALL; resistance; chemotherapy; glucocorticoid; IL7R signaling; PI3K-AKT-mTOR inhibitors; NOTCH1 inhibitors; BET inhibitors; CDK4/6 inhibitors; BCL2 inhibitors; selective inhibitor of nuclear export (SINE); DSRP T-ALL; resistance; chemotherapy; glucocorticoid; IL7R signaling; PI3K-AKT-mTOR inhibitors; NOTCH1 inhibitors; BET inhibitors; CDK4/6 inhibitors; BCL2 inhibitors; selective inhibitor of nuclear export (SINE); DSRP
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Follini, E.; Marchesini, M.; Roti, G. Strategies to Overcome Resistance Mechanisms in T-Cell Acute Lymphoblastic Leukemia. Int. J. Mol. Sci. 2019, 20, 3021.

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