Evolving Treatment Landscape of Acute Lymphocytic Leukemia

Hagop M. Kantarjian, MD, professor, department of Leukemia, division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses how the treatment landscape of acute lymphocytic leukemia (ALL) compares to what it used to be.

The ongoing paradigm shift in the treatment of ALL can be credited to the introduction of the BCR-ABL tyrosine kinase inhibitors as well as new antibodies targeting CD19, CD20 and CD22. Agents like ponatinib (Iclusig), blinatumomab (Blincyto), inotuzumab ozogamicin (Besponsa) have also yielded positive results in regard to survival and rates of remission within this patient population.

Kantarjian hopes that by combining these agents with one another or with chemotherapy will better the cure rate of patients with Philadelphia chromosome-positive ALL and pre B-cell ALL.

Transcription:

0:08 | In acute lymphocytic leukemia, I think there's now a paradigm shift in the cytopathic approaches. This is because we started introducing targeted therapies like the BCR-ABL tyrosine kinase inhibitors in Philadelphia-positive acute lymphocytic leukemia, as well as introducing the antibodies targeting CD19 and CD22.

0:32 | In Philadelphia-positive acute lymphocytic leukemia, using the third generation TKIs like ponatinib in combination with blinatumomab, which is a CD19 bispecific T-cell engager, we found that we can induce almost all patients in remission. The estimated 2 year survival is over 90%, and we are not needing to send the patients to transplant. We have shifted from a combination of intensive chemotherapy with first and second generation TKIs and relying on allogeneic transplantation to a strategy that has no chemotherapy, no need for transplant, and a very high cure potential.

1:17 | In pre B-cell acute lymphocytic leukemia, we introduced both blinatumomab and inotuzumab into the frontline therapy with less chemotherapy. We again found that almost all patients achieved a complete remission, and at 3 to 4 years, their estimated survival is over 80%, which is the first time that we've seen such survivor rates at MD Anderson. I'm hoping that 5 years from now, there's going to be a therapeutic revolution in ALL instead of giving 3 years of intensive chemotherapy in adults and older patients. I hope for a cure rate of 40- 50% so we will be able to give the newer regimens and double the cure rate to levels which are similar to childhood ALL.