iwAL 2019 | Changes in ALL therapy

Farhad Ravandi, MD:               Well, ALL in general has also shown dramatic change over the last five or six years, and that’s introduction of tyrosine kinase inhibitors in Ph-positive ALL, but also introduction of monoclonal antibodies Blinatumomab and Inotuzumab.

Farhad Ravandi, MD:              So, in Ph-positive ALL, specifically, addition of tyrosine kinase inhibitors, initially we did Imatinib, almost twenty years ago. And then later, with second generation drugs like Dasatinib or Nilotinib, and now the third generation drug Ponatanib has clearly improved the outcome of patients with Ph-positive ALL.

Farhad Ravandi, MD:               In the pediatric population for example, the studies by Children’s Oncology Group have shown that they can actually reduce the rate of allogeneic stem cell transplant in pediatric Ph-positive ALL dramatically just by introduction of TKIs into their regimens.

Farhad Ravandi, MD:                In the adult population, allogeneic stem cell transplant remains the standard of care for patients who are treated with chemotherapy, plus either Imatinib or Dasatinib in the younger population who can tolerate transplant. In the older population or in patients who can not have a transplant, either because of lack of donor or organ dysfunction and poor performance status, there have been studies that have shown that you can produce long term survivors with chemotherapy plus TKI regimens in a fair proportion of patients, in up to about half of the patients.

Farhad Ravandi, MD:                So clearly this was a disease that used to be extremely difficult to treat, especially if you didn’t have an allogeneic transplant option. But the introduction of TKIs has begun to transform it to a potentially curable disease for a majority of patients.