Genomic landscape of adult B-cell precursor acute lymphoblastic leukemia

Adult B-cell precursor acute lymphoblastic leukemia (BCP-ALL) is usually classified by the presence or absence of Philadelphia chromosome (Ph), although Ph-negative BCP-ALL is not a homogenous group in terms of genetic and clinical characteristics. While in pediatric BCP-ALL, cytogenetic classification has a long-standing role in risk prediction and treatment stratification; genetic alterations and their prognostic relevance are poorly known in adult BCP-ALL. Recently, the development of high-throughput genome-wide analyses has allowed identifying many recurrent alterations in children and adult BCP-ALL. Ten years ago, the BCR-ABL1-like or Ph-like group was described in pediatric studies and the importance of this group in adult was subsequently recognized. Evaluation of new therapeutic options in this high-risk group is currently an important field of treatment development. More recently, genomic alterations have been identified, defining novel subtypes, such as DUX4/ERG, ZNF384, ME2D and PAX5(P80R). These multiple classifying alterations, together with a lot of additional alterations, draw a new genomic landscape of adult BCP-ALL of unanticipated complexity. Understanding the biology of these leukemias, analyzing their clinical features and response to drugs are rapidly evolving fields that should speed up the development of more precise and efficient treatments.