ASH 2025 | Comparing chemotherapy plus ponatinib or imatinib in older patients with newly diagnosed Ph+ ALL

I presented a study on the behalf of the EWALL PH group. It’s the European Working ALL group treated mainly with older ALL and in this study we aimed it was initially designed as a three-arm study comparing TKI first and third generation to a third arm which is an exploratory arm, chemo-free with blinatumumab and ponatinib. Unfortunately, due to the withdrawal of the support of blinatumumab, the trial was amended to continue with two arms, comparing ponatinib and imatinib to the conventional chemotherapy treatment of the EU1.1. 

This was an older ALL patient mainly included. As we know, the TKI, mainly ponatinib, is known to have a higher toxicity, especially vascular toxicity. The first thing we found is that we have a very old population – the median age was 66 years old, and we have 60% patients aged over 70 years, in the ponatinib arm and 11% in the imatinib arm. 

So the adverse event was as expected as a hematologic adverse event, but in the non-hematologic adverse event, we didn’t find a lot of many adverse events, only two cardiovascular and arterial thromboembolism, and this was comparable to the imatinib arm. So this is a well-tolerated treatment. 

So what this means is that we can treat patients with adapted high-intensity chemotherapy combined with TKI. To date, we think that this CNS active disease associated with chemotherapy, methotrexate, and cytarabine, combined with the prophylactic intrathecal chemotherapy, may have a sense that we don’t know any CNS disease erupts up to now. What we highlight is the good molecular response in this population in the ponatinib arm up to 64.7% compared to 43.7% in the imatinib arm. Although this was not statistically significant, but it may be higher than other clinical trials comparing the same molecules.

This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.