Symbolic image of a leukemia patient crossing a DNA bridge towards remission.

Hope for Relapsed Leukemia: A New Protocol Shows Promise

Jordan Keane in Health & Wellness December 2025 • 4 min read.

"Bortezomib-based therapy offers a high remission rate with manageable side effects for adults battling relapsed or refractory acute lymphoblastic leukemia."

Relapsed or refractory acute lymphoblastic leukemia (RR-ALL) presents a significant treatment hurdle, demanding innovative strategies to improve patient outcomes. While advances like immunotherapy have emerged, the need for effective, well-tolerated therapies remains critical.

A recent study, originally designed for children with RR-ALL, explored a protocol combining bortezomib with standard chemotherapy agents. Encouraging results prompted researchers to investigate its potential in adult patients, focusing on remission rates and safety.

This article delves into the findings of that study, examining the effectiveness and tolerability of a bortezomib-based protocol in adult patients with RR-ALL. We'll explore how this approach offers a potential bridge to more definitive therapies, like bone marrow transplantation or immunotherapy, while minimizing adverse effects.

Bortezomib: A New Hope for Adult RR-ALL Patients?

Symbolic image of a leukemia patient crossing a DNA bridge towards remission.

Researchers implemented a protocol combining bortezomib, dexamethasone, asparaginase, doxorubicin, and vincristine in adult RR-ALL patients (>18 years). They then evaluated the remission rate and toxicity. The study included nine patients who had previously undergone multiple chemotherapy regimens, with two having relapsed after allogeneic bone marrow transplantation.

Remarkably, all five patients with B-ALL and two of the four patients with T-ALL achieved complete remission. Among those who achieved complete remission, two underwent allogeneic bone marrow transplantation, two received blinatumomab, and one received donor lymphocyte infusion followed by blinatumomab. In total, five out of the nine patients (55%) were able to proceed to further treatment in complete remission.

High Remission Rate: A significant percentage of patients achieved complete remission, opening doors for further treatment options.
Manageable Toxicity: The protocol demonstrated minimal adverse effects, primarily hematological toxicity, making it a well-tolerated option.
Bridge to Advanced Therapies: The protocol served as an effective bridge to more definitive treatments like immunotherapy or bone marrow transplantation.

The study concludes that the bortezomib-based protocol holds promise as an effective and well-tolerated treatment option for adult patients with RR-ALL, especially those who are unfit for or have failed standard salvage chemotherapy. It can serve as a bridge to immunotherapy or allogeneic bone marrow transplantation.

Future Directions: Paving the Way for Personalized Leukemia Treatment

These findings add to the growing body of evidence supporting the use of bortezomib in treating ALL. While the study's scope is limited, its results warrant further investigation through larger phase II trials. These trials could focus on defining the efficacy of the bortezomib-based regimen in a relapsed/refractory setting as a bridge to allogeneic transplant or immunotherapy.

The assessment of clonal B-cell IgH rearrangement and T-cell receptor rearrangement offers a promising avenue for monitoring treatment response. Further research is needed to establish their role as quantitative MRD markers.

By personalizing treatment strategies and tailoring therapies to individual patient profiles, we can continue to improve outcomes and quality of life for those battling this challenging disease. The future of RR-ALL treatment lies in innovative approaches and a commitment to research and development.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1159/000493252, Alternate LINK

Title: A Bortezomib-Based Protocol Induces A High Rate Of Complete Remission With Minor Toxicity In Adult Patients With Relapsed/Refractory Acute Lymphoblastic Leukemia

Subject: Hematology

Journal: Acta Haematologica

Publisher: S. Karger AG

Authors: Boaz Nachmias, Adir Shaulov, Moshe E. Gatt, Michael Shapira, Alexander Gural

Published: 2018-01-01

Everything You Need To Know

What is the new treatment approach discussed?

The study introduces a new protocol for adult patients with relapsed or refractory acute lymphoblastic leukemia (RR-ALL) that combines bortezomib with other chemotherapy agents. This novel approach aims to improve patient outcomes in RR-ALL, where standard treatments have often failed. Its significance lies in providing a potentially effective treatment option for patients who have exhausted other therapies, offering a bridge to more definitive treatments like bone marrow transplantation or immunotherapy.

What medications are used in the new protocol?

The protocol includes bortezomib, dexamethasone, asparaginase, doxorubicin, and vincristine. This combination was evaluated in adult patients with relapsed or refractory acute lymphoblastic leukemia (RR-ALL). The choice of these agents, including bortezomib, is based on their known efficacy in treating leukemia and their potential to work synergistically, improving the chances of remission.

What were the key findings of the study, and why are they important?

The study found that a significant number of patients achieved complete remission, with specific remission rates reported for B-ALL and T-ALL subtypes. The impact of this finding is substantial, as complete remission provides a window of opportunity for further, potentially curative, treatments. Moreover, it is important because it demonstrates that the new protocol is well-tolerated and has manageable side effects, primarily hematological toxicity. This is important because it means more patients can withstand the treatment without severe adverse events.

How does this treatment protocol fit into the overall treatment strategy for RR-ALL?

The protocol's role is to serve as a bridge to more definitive therapies. In the study, some patients in complete remission underwent allogeneic bone marrow transplantation or received immunotherapy with blinatumomab. The protocol helps stabilize the patient's condition and reduce the leukemia burden. This creates a window of opportunity to pursue potentially curative therapies. The benefit is that these more advanced treatments can provide a higher chance of long-term remission or a cure.

What are the next steps in the research or future directions?

Future research will focus on larger trials to confirm the protocol's effectiveness and explore its use in different patient populations and treatment settings. It is important to understand the protocol's efficacy in relapsed/refractory settings, as a bridge to allogeneic transplant or immunotherapy. This also includes personalized treatment approaches, potentially tailoring the protocol based on the specific characteristics of the patient's leukemia. This research will refine treatment strategies and improve outcomes for adults with RR-ALL.