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Recent Progress in Biological and Molecular Mechanisms and Targeted Therapies of Leukemia

A special issue of International Journal of Molecular Sciences (ISSN 1422-0067). This special issue belongs to the section "Molecular Pathology, Diagnostics, and Therapeutics".

Deadline for manuscript submissions: 20 February 2026 | Viewed by 338

Special Issue Editor


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Guest Editor
Department of Medical Science, Surgery and Neuroscience, University Hospital of Siena, Siena, Italy
Interests: chronic myelogenous leukemia; treatment free remission; CD26+; leukemia stem cell; TKI; flow cytometry

Special Issue Information

Dear Colleagues,

Recent advancements in the understanding of leukemia have significantly improved the development of targeted therapies. Acute myeloid leukemia (AML) has seen major progress in molecular profiling, leading to better classification and risk stratification of the disease. This has resulted in the identification of specific genetic mutations, which are now targeted by new therapies. The introduction of low-intensity induction therapies, such as hypomethylating agents combined with venetoclax, has substantially improved outcomes for patients, especially those with poor prognoses. Additionally, targeted oral therapies against driver mutations have expanded the treatment options available. Regarding Chronic Myeloid Leukemia (CML), the excellent progress induced by tyrosine kinase inhibitors (TKIs) has dramatically improved the prognosis for CML patients, allowing many to achieve long-term remission. However, the resistance to TKIs in some CML patients necessitates ongoing research into new therapeutic strategies and combination treatments with the aim to offer a safe TKIs discontinuation and to eradicate the leukemic residual disease. Acute Lymphoblastic Leukemia (ALL) and Chronic Lymphocytic Leukemia (CLL) have benefited from targeted therapies and immunotherapies. CAR-T cell therapies, which genetically modify the patient's immune cells to fight cancer, have shown promising results, especially for ALL. Monoclonal antibody therapies and immune checkpoint inhibitors are other options being studied and used for various types of leukemia. Despite these advancements, challenges remain, particularly in overcoming resistance mechanisms that arise during treatment. Understanding these resistance pathways is crucial for developing combinatorial and sequential therapeutic approaches to enhance patient survival.

List of the main relevant topics:

  1. Molecular Profiling and Genetic Mutations: Identification and targeting specific genetic mutations in leukemia.
  2. Low-Intensity Induction Therapies: Use of hypomethylating agents combined with venetoclax.
  3. Targeted Therapies: Development of therapies against driver mutations.
  4. TKIs: Impact on Chronic Myeloid Leukemia (CML) prognosis and challenges with resistance.
  5. CAR-T Cell Therapies: Genetic modification of immune cells for Acute Lymphoblastic Leukemia (ALL).
  6. Monoclonal Antibody Therapies: Targeting specific proteins on leukemia cells.
  7. Immune Checkpoint Inhibitors: New options for various types of leukemia.
  8. Resistance Mechanisms: Understanding and overcoming resistance pathways in treatment.

Dr. Anna Sicuranza
Guest Editor

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Keywords

  • leukemia-targeted therapies
  • AML
  • CML
  • venetoclax combination therapy
  • tyrosine kinase inhibitors (TKIs)
  • hypomethylating agents
  • ALL
  • CLL
  • CAR-T cell therapy
  • monoclonal antibodies
  • immune checkpoint inhibitors
  • resistance mechanisms

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Published Papers (2 papers)

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Research

12 pages, 1823 KB  
Article
Peripheral Blood as a Diagnostic Alternative to Bone Marrow in Immunophenotyping Pediatric B-Cell Acute Lymphoblastic Leukemia
by Alberto Daniel Saucedo-Campos, Maria Jose Lopez Chee, Myriam Campos-Aguilar, Wilfrido David Tapia-Sánchez, Sandra Olivas-Quintero, Adolfo Rene Méndez-Cruz, Julia Reyes-Reali, Maria Isabel Medoza-Ramos, Rafael Jiménez-Flores, Glustein Pozo-Molina, Victor Hugo Rosales-García and Alberto Ponciano-Gómez
Int. J. Mol. Sci. 2026, 27(1), 193; https://doi.org/10.3390/ijms27010193 (registering DOI) - 24 Dec 2025
Abstract
Flow cytometric immunophenotyping is essential for the diagnosis and immunologic classification of B-cell acute lymphoblastic leukemia in children and is traditionally performed using bone marrow aspirates, an invasive procedure that may be delayed or unavailable in certain clinical contexts. However, many patients present [...] Read more.
Flow cytometric immunophenotyping is essential for the diagnosis and immunologic classification of B-cell acute lymphoblastic leukemia in children and is traditionally performed using bone marrow aspirates, an invasive procedure that may be delayed or unavailable in certain clinical contexts. However, many patients present with circulating blasts at diagnosis, raising the possibility of using peripheral blood as an alternative source for initial immunophenotypic classification. Although previous studies have shown that peripheral blood can support initial diagnostic classification, they have not determined the degree of marker-level concordance between peripheral blood and bone marrow nor the clinical conditions under which this concordance is strongest. In this study, we evaluated the immunophenotypic concordance between peripheral blood and bone marrow in 32 pediatric patients with B-cell acute lymphoblastic leukemia, using paired samples obtained at diagnosis and analyzed with a standardized panel of B-lineage and maturation markers. Accordingly, the objective of this study was to quantify marker-specific agreement between compartments and identify clinical factors associated with higher concordance. Overall concordance was moderate across all subpopulations (mean CCC ~0.63) but higher for the markers most relevant to routine diagnostic classification (e.g., CD19+, CD10+, CD34+, and HLA-DR+), several of which exceeded 95% concordance and showed minimal bias between specimens. These findings apply only to newly diagnosed B-ALL with sufficient circulating blasts, as cases with minimal residual disease, low-blast presentations, atypical immunophenotypes, or mixed-lineage leukemias were not included in this study. The greatest concordance was seen in patients with hemoglobin < 8 g/dL, in whom extensive marrow infiltration promotes blast spillover into circulation. Likewise, patients older than 10 years showed high concordance, consistent with greater leukemic burden at presentation. Even in subgroups with lower circulating blast levels, such as those with hemoglobin ≥ 8 g/dL, peripheral blood adequately reproduced most leukemic cell populations present in bone marrow. Overall, these findings indicate that the markers and subpopulations most relevant for diagnostic immunophenotyping can be reliably assessed using peripheral blood in high-burden disease settings, reducing the immediate need for invasive procedures and facilitating timely immunophenotypic classification, particularly in resource-limited environments or situations where rapid initiation of treatment is critical. Full article
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11 pages, 904 KB  
Article
Association of Galectin-9 Soluble Immune Checkpoint with Clinical Prognostic Markers in Patients with Chronic Lymphocytic Leukemia
by Aviwe Ntsethe, Phiwayinkosi Vusi Dludla and Bongani Brian Nkambule
Int. J. Mol. Sci. 2026, 27(1), 98; https://doi.org/10.3390/ijms27010098 (registering DOI) - 22 Dec 2025
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Abstract
Chronic lymphocytic leukemia (CLL) is a heterogenous disease, with varied clinical outcomes. Multiplex assays used to measure soluble immune checkpoints offer a less laborious method of monitoring patients with CLL, but none of these panels have been validated. The aim of the study [...] Read more.
Chronic lymphocytic leukemia (CLL) is a heterogenous disease, with varied clinical outcomes. Multiplex assays used to measure soluble immune checkpoints offer a less laborious method of monitoring patients with CLL, but none of these panels have been validated. The aim of the study was to assess soluble immune checkpoint profiles in patients with CLL and to correlate these with independent prognostic markers such as β2-microglobulin (B2M), Rai stage, fluorescence in situ hybridization (FISH) status, and the International Prognostic Index for Chronic Lymphocytic Leukemia (CLL-IPI). We measured plasma levels of soluble interleukin-2 receptor alpha (sCD25), T cell immunoglobulin and mucin domain-containing protein 3 (TIM-3), galectin-9, programmed cell death 1 (PD-1), programmed death-ligand 1 (PD-L1), and cytotoxic T-lymphocyte associated protein 4 (CTLA-4) using cytometric bead array-based assays. We further measured plasma levels of B2M using an enzyme-linked immunosorbent assay (ELISA) kit. Soluble immune checkpoints were correlated with prognostic markers. The plasma levels of sCD25, TIM-3, galectin-9, PD-1, and PD-L1 were significantly increased in patients with CLL compared to the control group, p < 0.0001. Galectin-9 plasma levels were directly associated with B2M levels (β = 0.65, p = 0.012). Our findings suggest that galectin-9 may provide valuable prognostic significance for patients with CLL. Full article
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