ASH 2024 | Exciting ALL updates from ASH 2024

What is the latest news for the patient with ALL? I think that this year there are many, many good news for patients with ALL at ASH. Really, I think that is perhaps over the last ASH meetings, the meeting that has more information on ALL. For example, one confirms with an independent study the efficacy of the combination of ponatinib and blinatumomab without chemo in Ph-positive ALL. So it’s really a good view that not only one study suggests or demonstrates the effectiveness, but another independent study confirms absolutely the results of this combination. This is one study. There are other studies incorporating, for example, inotuzumab in first line, in a Phase III study that demonstrates that it’s feasible in adolescents and young adults, but perhaps a reduced dose is needed because there is a significant increase in infections. But this implies that inotuzumab could be used also in the first line as is done by blinatumomab but caution on those is needed. This is another important issue. 

Another important issue in CAR-T is the evidence that MRD after CAR-T in the newly approved CAR-T has an important impact on prognosis as occurs with the other two CD19 CAR-Ts. Another issue of interest. 

Another issue, it could be data from reinfusion or second infusion of CAR-T, the efficacy of second infusions, this is good. Another is the evidence in a randomized trial from the German group that allogeneic transplantation could be omitted in patients that are persistently MRD negative after induction and consolidation in adult patients, that it’s an important issue for reducing the need of allogeneic stem cell transplantation. 

Another interesting study from China is the combination of homoharringtonine and venetoclax in early T-cell precursor ALL with astonishing results, the best results that I have seen in this subset of patients with poor prognosis. So, there are many other results that now in summary, there are exciting issues and promising updates that will change for sure the management of patients with ALL, especially in first line. Because there are improvements that drugs approved for relapse and refractory are moved to first line with improved results that at the end will imply that we will increase the survival of adult ALL over 50%. 50% is the top with chemotherapy. So when introducing immunotherapy and targeted therapies, I think we can surpass 60%. And this is a major achievement in the treatment of adult ALL. So there are some different steps that are published in different abstracts at ASH. But really, all of them are in the same direction – incorporate the advances in relapse and refractory ALL to first-line ALL with a positive result.

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