The Community Focus Channel on VJHemOnc is an independent medical education platform, supported with funding from Johnson & Johnson (Gold). Supporters have no influence on the production of content. The levels of sponsorship listed are reflective of the amount of funding given.
SOHO 2025 | Current approaches to the management of high-risk Ph+ ALL
Nicholas Short, MD, The University of Texas MD Anderson Cancer Center, Houston, TX, discusses the management of high-risk Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL), highlighting that the definition of this subtype is evolving as therapeutic approaches to the disease change. Dr Short outlines the approach to managing high-risk Ph+ ALL at his institution, noting some of the strategies being tested to improve clinical outcomes in this patient population. This interview took place at the 13th Annual Meeting of the Society of Hematologic Oncology (SOHO 2025) in Houston, TX.
These works are owned by Magdalen Medical Publishing (MMP) and are protected by copyright laws and treaties around the world. All rights are reserved.
Transcript
So the definition of high-risk Ph-positive ALL is really evolving and it really is linked with the types of therapies that we use. So historically with intensive chemotherapy plus TKIs, we saw that for example additional chromosomal abnormalities were associated with worse outcomes as well as IKZF1 plus genotype. We saw as well with for example the chemotherapy-free regimens like dasatinib and blinatumomab that IKZF1 plus genotype was also associated with poor outcomes...
So the definition of high-risk Ph-positive ALL is really evolving and it really is linked with the types of therapies that we use. So historically with intensive chemotherapy plus TKIs, we saw that for example additional chromosomal abnormalities were associated with worse outcomes as well as IKZF1 plus genotype. We saw as well with for example the chemotherapy-free regimens like dasatinib and blinatumomab that IKZF1 plus genotype was also associated with poor outcomes. But we’ve seen more recently with blinatumomab and ponatinib that the only factor that we’ve found to be associated with worse outcomes was high white count at presentation. As well, we know that post-treatment outcomes, for example, MRD response is associated with risk of relapse. So patients that have poor MRD clearance or suboptimal MRD clearance are more likely to relapse.
So it really is evolving with the types of therapies that we use. At MD Anderson, our primary approach is to use blinatumomab and ponatinib. And for patients treated with this regimen, we really only consider patients with a high white count at presentation that’s over 70,000 to be high risk. So how do we try to improve outcomes for these patients who actually could have a relapse rate as high as 50%? We’ve introduced two cycles of high-dose chemotherapy into the blinatumomab-ponatinib regimen. The goal is to, with high-dose methotrexate and cytarabine, that this could hopefully penetrate into the blood-brain barrier and help prevent CNS relapses. We also try to send these patients for CAR T-cell consolidation on a clinical trial. So the results are still early, but we’re hoping that we’ll see better outcomes with these strategies, and we’re still trying to avoid transplant for these patients. So even high-risk, Ph-positive ALL, our goal is to avoid transplant and try to cure them with just immunotherapy, perhaps some amount of chemotherapy as well as CAR T-cells.
This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.
Read more...
