Pharmacogenetics of acute lymphoblastic leukemia treatment response

Acute lymphoblastic leukemia is the most common childhood cancer and generally has a favorable prognosis. However, some children experience disease relapse or clinically important treatment-related toxicities. Although some of the risk factors for treatment failure and toxicity are known, these risk factors still imperfectly predict relapse and toxicity. Genetic variation in the enzymes of the folic acid cycle, one-carbon transfer, immune surveillance, drug metabolism and transport may determine some of the variability in treatment response. This review summarizes the present published literature on the role of these genetic polymorphisms in determining treatment response. Despite these recent advances, further work is needed to develop clinically useful genetic predictors of leukemia treatment response.