EHA 2025 | Could BCL2 inhibition play a role in the management of adult ALL?

So, BCL2 inhibition in ALL has been explored in several clinical trials. So, we just recently published the experience between MD Anderson and Dana-Farber, where venetoclax was added to mini-CVD type of induction chemotherapy in older patients with ALL, frontline patients newly diagnosed, and the results were quite good with high overall response rate, high MRD-negative rate, good survival. And of course all the patients have limited options because they cannot tolerate chemotherapy. But we also now have the options of monoclonal antibodies, which is why BCL2 inhibition has been a bit delayed in development compared to the other options. 

There was also interesting work presented by Dr Ibrahim Aldoss from City of Hope at last, I believe, EHA or ASH, where he showed the combination of venetoclax with intensive chemotherapy benefits high-risk patients, such as patients with Ph-like ALL lesions. Of course, after that, the patients have undergone blinatumomab therapy and some of them transplant, but still this data is quite encouraging as far as use of BCL2 inhibitors in ALL. 

So I think from my perspective, scientific perspective, it should be added to the frontline chemotherapy. Unfortunately there is a little interest at this point from the pharma companies to support that in ALL because there are so many other options but hopefully we’ll find some solution to that and maybe we are trying to work with some companies in the settings of large trials.

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