Acute Lymphoblastic Leukemia (ALL) Medications List -

Acute Lymphoblastic Leukemia (ALL) is a type of cancer that starts in the white blood cells inside the bone marrow. This type of cancer worsens quickly if it is not treated on time.

Here we have provided a list of all the approved and effective Acute Lymphoblastic Leukemia medications.

Drug Class	Drug Name
Corticosteroids	Prednisone Dexamethasone
Vinca Alkaloid	Vincristine
Antimetabolite	Methotrexate Cytarabine Mercaptopurine
Alkylating Agent	Cyclophosphamide
Anthracenedione	Mitoxantrone
Purine Nucleoside Analogue	Nelarabine Clofarabine
Tyrosine Kinase Inhibitor	Imatinib mesylate Nilotinib Ponatinib
Chimeric Antigen Receptor T-cell Therapy	Tisagenlecleucel
Granulocyte Colony-Stimulating Factor	Filgrastim Pegfilgrastim
Antifungal	Itraconazole Clotrimazole
Anthracycline Antibiotic	Daunorubicin Idarubicin
Monoclonal Antibody	Inotuzumab
Enzyme	Asparaginase Erwinia chrysanthemi Calaspargase pegol Pegaspargase
Bispecific T-cell Engager	Blinatumomab

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Prednisone for ALL

Generic name: Prednisone

Trade name: Deltasone, Rayos, Winpred

Company name: Geneyork Pharmaceutical

Date of approval: (not available for ALL)

MOA:

Prednisone reduces inflammation by preventing polymorphonuclear leukocyte movement and turning back enhanced capillary permeability. Additionally, it inhibits the immune system by lowering its volume and activity.

Uses:

It is frequently used together with chemotherapy to aid in the destruction of leukemia cells or to lessen adverse responses to some chemotherapy medications.

Major contraindications:

Documented hypersensitivity
Administration of live or attenuated live vaccine
Untreated serious infections
Varicella

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Dexamethasone for ALL

Generic name: Dexamethasone

Trade name: Baycadron, Decadron, Ciprodex, Dexamethasone Intensol, Dioptrol, Hexadrol, Dextenza, Maxidex, Neofordex, Taperdex 12 Day Taper, Tobradex

Company name: Pfizer CentreOne

Date of approval: Not available for ALL

Mode of action: The body is affected by dexamethasone in a number of different ways.

It functions by preventing neutrophil migration and reducing lymphocyte colony growth.
Stabilizes cell and lysosomal membranes
Increases surfactant synthesis
Raises serum vitamin A concentration
Inhibits prostaglandin and proinflammatory cytokines.

It also inhibits mitosis, breaks down granulocyte aggregates, reduces capillary permeability

Uses:

It treats specific types of arthritis, skin, blood, kidney, eye, thyroid, and intestinal problems (including colitis), severe allergies, and asthma by reducing inflammation (swelling, heat, redness, and discomfort). There are several cancers that can be treated with dexamethasone.

Major contraindications:

Cerebral malaria
Documented hypersensitivity
Systemic fungal infection
Patients taking immunosuppressive dosages of corticosteroids should not get live, attenuated vaccinations.

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Vincristine for ALL

Generic name: Vincristine

Trade name: Marqibo, Vincasar, Vincasar PFS, Oncovin.

Company name: Eli Lilly Company

Date of approval: August 9, 2012 [ref]

MOA:

Vincristine’s anticancer effects are assumed to be predominantly a result of tubulin-mediated suppression of mitosis during metaphase.

Vincristine, like other vinca alkaloids, may impair the metabolism of amino acids, cyclic AMP, and glutathione, as well as cellular respiration, calmodulin-dependent Ca2+-transport ATPase activity, nucleic acid synthesis, and lipid synthesis.

Uses:

Brain tumors, small cell lung cancer, Acute Lymphoblastic Leukemia (ALL), Wilms’ tumor, neuroblastoma, sarcomas, Hodgkin disease, AML, CML.

Major contraindications:

Hypersensitivity
Intrathecal (IT) administration
Charcot-Marie-Tooth syndrome (demyelinating form)

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Methotrexate for ALL

Generic name: Methotrexate

Trade name: Nordimet, Rasuvo, Trexall, Metoject, Otrexup, Reditrex, Xatmep

Company name: Lederle Laboratories

Date of approval: February 26, 1999 [ref]

MOA: Methotrexate’s methods of action are complex. Methotrexate, a folic acid analog, suppresses the production of purines and pyrimidines, which explains both its effectiveness in the treatment of cancer and some of its side effects.

Uses: it is used in the therapy of advanced non-Hodgkin’s lymphoma, breast cancer, advanced mycosis fungoides, and acute lymphocytic leukemia.

Major contraindications:

Hypersensitivity, Pregnant women who have the nonmalignant disease

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Cyclophosphamide for ALL

Generic name: Cyclophosphamide

Trade name: Procytox, Cytoxan

Company name: Baxter Oncology

Date of approval: August 17, 1999 [ref]

MOA:

Cyclophosphamide is a nitrogen mustard-type alkylating agent. Cross-linking of DNA and RNA strands and the suppression of protein synthesis are the principal causes of its cytotoxic effects.

Uses:

It is used for the therapy of multiple myeloma, leukemias, mycosis fungoides, malignant lymphomas, retinoblastoma, neuroblastoma, and adenocarcinoma of the ovary.

Major contraindications:

Hypersensitivity
Severe myelosuppression
Urinary outflow obstruction

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Cytarabine for ALL

Generic name: Cytarabine

Trade name: Cytosar, Vyxeos

Company name: Pfizer Inc.

Date of approval: Not available for ALL

MOA:

Direct DNA damage and integration into DNA are how cytarabine works. It appears to function by inhibiting DNA polymerase, while the exact mechanism of action is yet unclear. There has also been evidence of a small but considerable incorporation of cytarabine into both DNA and RNA.

Uses:

Acute lymphoblastic leukemia, acute myeloid leukemia, and chronic myeloid leukemia are conditions for which Cytarabine is occasionally used.

Major contraindications:

Hypersensitivity, ongoing meningeal infection

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Mitoxantrone for ALL

Generic name: Mitoxantrone

Trade name: Novantrone

Company name: Amgen Inc.

Date of approval: Not available for ALL

MOA:

Mitoxantrone works by intercalating with the DNA molecule, which leads to single and double-stranded breaks and inhibits DNA repair by inhibiting topoisomerase II. B and T lymphocyte proliferation, as well as that of macrophages, is strongly inhibited by mitoxantrone.

Uses:

Acute lymphoblastic leukemia is another condition for which mitoxantrone injection is occasionally used.

Major contraindications:

Hypersensitivity

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Nelarabine for ALL

Generic name: Nelarabine

Trade name: Arranon, Atriance

Company name: GlaxoSmithKline

Date of approval: October 28, 2005 [ref]

MOA:

Nelarabine breaks down into ara-GTP, which then builds up in leukemic blasts and binds to DNA to exert its S phase-specific cytotoxic actions that cause fragmentation and apoptosis.

Ara-GTP and endogenous deoxyGTP (dGTP) fight with one another for DNA synthesis. Apoptosis is signaled and causes cellular death after ara-GTP is integrated at the 3′ end of DNA, inhibiting further DNA elongation. There may be other cytotoxic actions as well, but we don’t completely understand them.

Uses:

It is used for the therapy of Acute T-cell lymphoblastic leukemia and T-cell lymphoblastic lymphoma in children and adults whose cancer has not responded to treatment or has relapsed after receiving at least two chemotherapy regimens.

Major contraindications:

None

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Imatinib mesylate for ALL

Generic name: Imatinib mesylate

Trade name: Gleevec

Company name: Novartis

Date of approval: May 20, 2003 [ref]

MOA:

A protein-tyrosine kinase inhibitor called imatinib mesylate prevents the constitutively abnormal bcr-abl tyrosine kinase from being produced by the Philadelphia chromosomal abnormalities in acute lymphoblastic leukemia (ALL)

Uses:

It is used in the therapy of Acute lymphoblastic leukemia with the Philadelphia chromosome in both adults and children

Major contraindications:

None

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Nilotinib for ALL

Generic name: Nilotinib

Trade name: Tasigna

Company name: Novartis

Date of approval: October 29, 2007 [ref]

MOA:

The BCR-ABL oncogene is the primary cause of chronic myelogenous leukemia (CML). The BCR-ABL protein’s tyrosine kinase activity is inhibited by nilotinib.

Higher affinities of nilotinib than imatinib allow it to attach to the ATP-binding site of the BCR-ABL protein and overcome mutation-based resistance.

The potential use of AMN107 for myeloproliferative diseases characterized by these kinase fusions is suggested by the drug’s ability to inhibit TEL-platelet-derived growth factor receptor-beta (TEL-PDGFRbeta), which causes chronic myelomonocytic leukemia, and FIP1-like-1-PDGFRalpha, which causes the hypereosinophilic syndrome.

Additionally, at pharmacologically acceptable doses, AMN107 inhibits the c-Kit receptor kinase, including the D816V-mutated form of KIT, suggesting potential benefit in the treatment of mastocytosis and gastrointestinal stromal tumors.

Uses: it is used in the therapy of chronic myelogenous leukemia with the Philadelphia chromosome in both adults and children.

Major contraindications:

Hypokalemia, long QT syndrome, hypomagnesemia

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Ponatinib for ALL

Generic name: Ponatinib

Trade name: Iclusig

Company name: ARIAD Pharmaceuticals

Date of approval: December 14, 2012 [ref]

Generic name: Daunorubicin

Trade name: Cerubidine

Date of approval: December 19, 1979 [ref]

Company name: Hikma Pharmaceuticals

Uses:

For the therapy of acute myeloid leukemia, and acute lymphocytic leukemia in children.

MOA:

This anthracycline antibiotic, daunorubicin harms DNA by intercalating between base pairs, which causes the helix to uncoil and ultimately prevents DNA synthesis and DNA-dependent RNA synthesis.

Major contraindications:

Active infection
Patients who have taken the maximum cumulative dosage of daunorubicin/doxorubicin
Hypersensitivity
IM or SC administration (vesicant)
Patients with already existing myelosuppression due to other drug therapies

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Idarubicin for ALL

Generic name: Idarubicin

Trade name: Idamycin

Date of approval: not available for ALL

Company name: Pfizer Oncology

Uses:

As a second-line treatment in patients with Acute lymphocytic leukemia whose cancer has relapsed or for acute myeloid leukemia.

MOA:

Idarubicin intercalates into DNA and disrupts the function of topoisomerase II, preventing the replication of DNA, transcription of RNA, and synthesis of proteins. Idarubicin penetrates cell membranes more effectively than other anthracycline antibiotic compounds because of its high lipophilicity.

Major contraindications:

Serum bilirubin above 5 mg/dL
Hypersensitivity

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Clofarabine for ALL

Generic name: Clofarabine

Trade name: Clolar, Evoltra

Date of approval: December 28, 2004 [ref]

Company name: Genzyme Corp.

Uses:

For the therapy of Acute Lymphoblastic Leukemia (ALL)

MOA:

This Purine nucleoside analog blocks DNA polymerases and ribonucleotide reductase.

Additionally, it could encourage mitochondria-mediated apoptosis.

Major contraindications:

Hypersensitivity

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Inotuzumab for ALL

Generic name: Inotuzumab ozogamicin

Trade name: Besponsa

Date of approval: Aug. 17, 2017 [ref]

Company name: Pfizer and UCB

Uses:

For the therapy of B-cell precursor acute lymphoblastic leukemia (ALL).

MOA:

Non-clinical data indicate that inotuzumab ozogamicin’s anticancer activity is a result of ADC binding to CD22-expressing tumor cells, internalization of the ADC-CD22 complex, and activation of N-acetyl-gamma-calicheamicin 19 dimethyl hydrazide, which causes double-strand DNA breaks and subsequently causes cell cycle arrest and apoptotic cell death.

Major contraindications:

None

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Asparaginase Erwinia chrysanthemi for ALL

Generic name: Asparaginase Erwinia chrysanthemi

Trade name: Erwinaze

Date of approval: November 18, 2011 [ref]

Company name: EUSA Pharma.

Uses:

For the management of acute lymphoblastic leukemia (ALL) patients with asparaginase hypersensitivity caused by E. coli

MOA:

This medication catalyzes the conversion of asparagine into aspartic acid and ammonia, lowering the amount of asparagine in the blood.

According to current theories, the mechanism of action is based on leukemic cells’ inability to manufacture asparagine due to a lack of asparagine synthetase activity.

Leukemic cells that rely on an external supply of the amino acid asparagine for their protein metabolism and survival experience cytotoxicity as a result of the absence of asparagine synthetase activity.

Major contraindications:

A history of disorders with previous L-asparaginase therapy including:

serious pancreatitis
serious hemorrhagic events
serious thrombosis

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Calaspargase pegol for ALL

Generic name: Calaspargase pegol

Trade name: Asparlas

Date of approval: December 20, 2018 [ref]

Company name: Servier Laboratories

Uses:

For the therapy of acute lymphoblastic leukemia.

MOA:

The pharmacological action is assumed to be based on the selective death of leukemic cells due to the depletion of plasma L-asparagine; leukemic cells with low asparagine synthetase expression have a diminished ability to manufacture L-asparagine and consequently depend on an external supply of L-asparagine for life.

Major contraindications:

A history of disorders with previous L-asparaginase therapy including:

serious pancreatitis
serious hemorrhagic events
serious thrombosis

Fatal hypersensitivity reactions such as anaphylaxis.

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Pegaspargase for ALL

Generic name: Pegaspargase

Trade name: Oncaspar

Date of approval: July 24, 2006 [ref]

Company name: Servier Laboratories

Uses:

For the therapy of acute lymphoblastic leukemia.

MOA:

The amino acid L-asparagine is converted into aspartic acid and ammonia by the pegylated L-asparaginase known as pegaspargase.

For the production of DNA and RNA as well as cell division, asparagine is a crucial amino acid. Since the majority of healthy human tissues can generate asparagine via the enzyme asparagine synthetase, it is not a necessary amino acid in humans.

Leukemia cells, on the other hand, have low quantities of this enzyme, making it impossible for them to synthesize asparagine, leaving them reliant on foreign supplies.

Pegaspargase may destroy leukemic cells by depleting plasma asparagine, according to some research.

Major contraindications:

A history of disorders with previous L-asparaginase therapy including:

serious pancreatitis
serious hemorrhagic events
serious thrombosis

Fatal hypersensitivity reactions such as anaphylaxis

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Blinatumomab for ALL

Generic name: Blinatumomab

Trade name: Blincyto

Date of approval: March 29, 2018 [ref]

Company name: Amgen Inc.

Uses:

For the therapy of relapsed acute lymphoblastic leukemia.

MOA:

Through the development of a synapse between the T-cell and the tumor cell, activation of cell adhesion molecules, the creation of cytolytic proteins, the release of inflammatory cytokines, and the proliferation of T cells, CD19+ cells are lysed in various locations.