Table 2.

New therapies for relapsed acute lymphoblastic leukemia

Investigational therapy	Pharmacologic classificatic	Indication	Stage of development	Overall response rate	Adverse effects
Clofarabine [36–38]	Nucleoside analogue	ALL/AML	FDA-approved in pediatric ALL; phase 2 (adults)	13%	Hepatotoxicity, rash, drug fever, palmoplantar erythrodysesthesia
Hyper-CVAD + dasatinib*  [49••]	Chemotherapy + tyrosine kinase inhibitor	Philadelphia chromo- some– positive ALL	Phase 2	100% in combination with chemotherapy	Bleeding, pleural and pericardial effusion, liver dysfunction
Sphingosomal vincristine  [40,41•,42]	Liposome-encapsulated vinca alkaloid	ALL	Phase 2	14%	Peripheral neuropathy, orthostasis, headache
Nelarabine [33]	Nucleoside analogue	T-cell ALL	FDA-approved	41%	Peripheral sensory neuropathy, seizure, fatigue, muscle weakness, gastrointestinal distress
Pegaspargase* [44,45]	Pegylated asparaginase	ALL	FDA-approved in pediatric ALL	96% in combination with chemotherapy	Hypersensitivity reactions, liver dysfunction, hyperglycemia, coagulation factor abnormalities, pancreatitis, cerebral dysfunction

^*Responses reported in combination with chemotherapy.

ALL—acute lymphoblastic leukemia; AML—acute myelogenous leukemia; FDA—US Food and Drug Administration; hyper-CVAD—vincristine, doxorubicin, and dexamethasone with hyper-cyclophosphamide.