Date of Award

Spring 2019

Document Type


Primary Advisor

Dr. Todd Schraw


Leukemia is the number one cancer affecting children in the nation, with acute lymphoblastic leukemia being the most prevalent classification.1 While new and innovative treatment protocols have greatly increased the success rate of primary cancer patients, those who face relapse receive a much more dismal prognosis. Recent studies have shown that patients who relapse quite frequently have developed drug-resistant clones of the original cancer cells, leading to a need for various secondary treatment options. The drug-resistance is due to clonal mutations that take place within the cancer cell, most often because of an outside pressure or stress within the environment of the cell. In fact, studies show that in many cases the chemotherapy and radiation treatment administered to the leukemia patients provides the added pressures necessary to promote these clonal mutations, leading to treatment-resistant cells and the onset of relapsed leukemia. Various immunotherapies are becoming the front-line secondary treatment option due to their high success rates and innovative techniques. Monoclonal antibodies such as Blinatumomab or Inatuzumab are currently the primary targets of research for acute lymphoblastic leukemia secondary therapy. However, dual therapy treatments of cancers have shown increased rates of event-free survival, overall survival, and progression-free survival, as well as decreased rates of drug resistant cancer cells. Therefore, the goal of this review is to promote the application of dual treatment therapy on relapsed ALL cells for improved outcome, as well as on primary ALL cells for decreased drug resistance.