ESH AL 2018 | The potential for a chemotherapy-free strategy in ALL

For elderly patients, it’s very difficult to go into transplant, so going back to your first question, is there a potential role for chemo-free strategy for ALL? As I see it, the possibility would be yes, we have to prove it, but at least we’ve shown that we can put patients into remission. Some patients obtain even a molecular remission, the key point is to become what we call MRD negative; molecular negativity. So now we’re combining new drugs; tyrosine kinase inhibitors plus very fancy immunotherapy now, it’s an era of immunotherapy. Where ever you go you read the newspapers, journals or CAR T therapy, whatever, so with the Italian study is just about the first is for the Philadelphia incorporating this bispecific monoclonal antibody blinatumomab tumor which is anti-CD3 and anti-CD19, targeting the leukemia cells CD19, but it’s immunotherapy; it’s activating the T-cells of the patient that goes against the CD19-positive leukemia cells. So we give an induction with steroids and tyrosine kinase inhibitors, and we are consolidating with the antibody, so the induction without chemotherapy, and a primary endpoint of this is a percent of patients who are going to become sustained MRD negative by quantitative PCR. And what would be the final goal? To reduce the number of transplants and, particularly in the elderly, it may be to control the disease. I will show tomorrow when I speak, I’ll start, here they want the case, so I’ll show them a case of a gentleman who in 2007 or 2008, I can’t remember off by heart, was diagnosed with ALL at the age of 89, even today quite mature. Luckily he was tested, there’s many places you wouldn’t do that, because so, you say well acute leukemia, what is the prognosis. Luckily he was tested in the [inaudible] and he was Philadelphia-positive so he was put on an inhibitor, he went into remission. You’re driving a car in Verona, not in Rome. Then imagine you relapse one and a half years later, we put him a second inhibit obtain a secondary remission. To make a long story short, the gentlemen lived two and a half years, he turned 90 and 91, and eventually died, so he had two and a half years with an acute leukemia; lymphoid leukemia, and now if he hadn’t been diagnosed having the Philadelphia chromosome, he would have died in three months, so that gives an example, targeted treatment even at a lethal condition like that, even in a very elderly patient and he’s not the only one, I was treating many patients.