In our department, we believe when effective drugs are approved in the relapsed setting in any disease, they should be moved forward to the frontline setting because really that’s where you will make the most impact in terms of patient outcomes. We don’t need to… we should not wait for the patient to relapse before we give them an effective drug. And this has been the case in ALL as well as other leukemias...
In our department, we believe when effective drugs are approved in the relapsed setting in any disease, they should be moved forward to the frontline setting because really that’s where you will make the most impact in terms of patient outcomes. We don’t need to… we should not wait for the patient to relapse before we give them an effective drug. And this has been the case in ALL as well as other leukemias. And so in ALL, we’ve been lucky for the last several years there have been a number of effective strategies that have come out. For example, addition of tyrosine kinase inhibitors to initially chemo regimens in Philadelphia positive ALL. Then more recently the development of blinatumomab, a bispecific antibody, which has been shown to be very effective in eradicating MRD with an MRD conversion rate of about 80%. And then also the antibody-drug conjugate inotuzumab which is also very effective, at least in the relapsed setting showing 80% response, close to 80% response rate in the randomized trial. So we are moving all of these towards the frontline setting, and in early small studies with reasonable follow-up, we are showing significant improvement in the efficacy and outcomes of the patients.