ESH AL 2026 | Challenges associated with Ph+ ALL: identifying high-risk patients & novel therapies being explored
In this video, Josep-Maria Ribera, MD, PhD, Germans Trias i Pujol University Hospital, Barcelona, Spain, discusses a debate at ESH AL 2026 that focused on the treatment of patients with Ph-positive acute lymphoblastic leukemia (Ph+ ALL). He highlights the challenges of treating a subset of high-risk patients who still relapse despite modern chemotherapy, and notes that new therapies, including next-generation TKIs, combination approaches, and the early use of CAR T-cells, may offer promising solutions. This interview took place at the 5th How to Diagnose and Treat: Acute Leukemias meeting of the European School of Hematology (ESH AL) in Mandelieu-La Napoule, France.
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Transcript
Well, in the debate, despite this optimistic view, there is a subset of patients between 10 and 20 percent, that still relapse with this modern chemotherapy. My question is that we have to first identify these patients, especially before relapse, of course. And second, to use alternative therapies or even to prevent the relapse. So what we have shown that those patients with hyperleukocytosis, those patients with IKAROS Plus signature, those patients who have a poor MRD clearance at three months are patients that experience a higher probability of relapse...
Well, in the debate, despite this optimistic view, there is a subset of patients between 10 and 20 percent, that still relapse with this modern chemotherapy. My question is that we have to first identify these patients, especially before relapse, of course. And second, to use alternative therapies or even to prevent the relapse. So what we have shown that those patients with hyperleukocytosis, those patients with IKAROS Plus signature, those patients who have a poor MRD clearance at three months are patients that experience a higher probability of relapse. Those patients should be quickly monitored and quickly treated when there is an impending relapse at MRD level. We have to not wait for another relapse. So this is the first thing. What armamentarium do we have? New TKI, for example, olverembatinib, a new TKI high spectrum, low toxicity, combination of this with immunotherapy, and the use, the premature use or the use in the early use of CAR-T. CAR-T have been, have shown highly active in relapsed/refractory Ph-positive ALL and there are preliminary experience on the incorporation of CAR T in the first line therapy with promising results. So I think I am optimistic that this 10 to 20 percent of patients who are still relapsed under modern chemotherapy will be cured or controlled in the near future.
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