B-cell acute lymphoblastic leukemia (B-ALL) is a rare malignancy in adults, with outcomes remaining poor, especially compared with children. Over the past 2 decades, extensive whole-genome studies have identified numerous genetic alterations driving leukemia, leading to the recognition of >20 distinct subtypes that are closely associated with treatment response and prognosis. In pediatric B-ALL, large correlation studies have made genetic classification a central component of risk-adapted treatment strategies. Notably, genetic subtypes are unevenly distributed according to age, and the spectrum of genetic alterations and their prognostic relevance in adult B-ALL have been less extensively studied, with treatment primarily based on the presence or absence of BCR::ABL1 fusion. This review provides an overview of genetic subtypes in adult B-ALL, including recent biological and clinical insights in well-established subtypes as well as data on newly recognized subtypes. Their relevance for risk classification, disease monitoring, and therapeutic management, including in the context of B-cell–directed therapies, is discussed. This review advocates for continuing efforts to further improve our understanding of the biology of adult B-ALL to establish the foundation of future precision medicine in B-ALL.
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Acute Lymphoblastic Leukemia|
April 3, 2025
Genetic subtypes of B-cell acute lymphoblastic leukemia in adults
Marie Passet,
Marie Passet
1Institut de Recherche Saint-Louis, Université Paris Cité, INSERM UMR1342, Paris, France
2Service d’Hématologie Biologique, Hôpital Saint-Louis, Assistance Publique–Hôpitaux de Paris, Paris, France
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Rathana Kim,
Rathana Kim
1Institut de Recherche Saint-Louis, Université Paris Cité, INSERM UMR1342, Paris, France
2Service d’Hématologie Biologique, Hôpital Saint-Louis, Assistance Publique–Hôpitaux de Paris, Paris, France
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Emmanuelle Clappier
Emmanuelle Clappier
1Institut de Recherche Saint-Louis, Université Paris Cité, INSERM UMR1342, Paris, France
2Service d’Hématologie Biologique, Hôpital Saint-Louis, Assistance Publique–Hôpitaux de Paris, Paris, France
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Blood (2025) 145 (14): 1451–1463.
Article history
Submitted:
June 3, 2024
Accepted:
November 26, 2024
First Edition:
December 30, 2024
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Citation
Marie Passet, Rathana Kim, Emmanuelle Clappier; Genetic subtypes of B-cell acute lymphoblastic leukemia in adults. Blood 2025; 145 (14): 1451–1463. doi: https://doi.org/10.1182/blood.2023022919
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