The introduction of effective novel agents is swiftly changing management of patients with Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL). In this edition of the “How I treat…” series in the Blood Journal, the author uses case studies to address questions about Ph+ ALL treatment decisions.
The case studies address important treatment questions:
- What are the current standards of care for young adults with no comorbidities?
- Can younger patients with no donor achieve long-term remission without allogeneic hematopoietic cell transplantation (HCT)?
- What are the best treatment strategies for older and unfit patients?
- What is the role of newer, more potent tyrosine kinase inhibitors (TKIs)?
- What are the potential options and outcomes for relapsed disease?
With younger, fitter patients, allogeneic HCT in first complete remission (CR1) remains the standard of care, often in combination with the use of first and second generation TKIs. However, adult and pediatric studies have shown adding early and continuous TKI therapy to traditional ALL-based regimens can be beneficial.
The author concludes that future availability of more effective novel agents, such as more potent TKIs, as well as better methods for monitoring minimal residual disease (MRD), offer a more promising outlook for PH+ ALL treatment. New treatment options may lessen dependence on allogeneic HCT and chemotherapy, as well as allow individualized therapy based on patient characteristics, donor availability and MRD clearance.