New Options Shape the Treatment Landscape of ALL

Aaron Logan, MD, PhD, assistant professor of Clinical Medicine, University of California San Francisco, discusses some of the treatment options available for patients with acute lymphoblastic leukemia (ALL).

New therapies such as blinatumomab (Blincyto), inotuzumab (Besponsa), and chimeric antigen receptor (CAR)-T cells, have made the management of patients with ALL both complex and positive. Some agents, including blinatumomab, are even being moved into the frontline setting.

During a session at the National Comprehensive Cancer Network 2022 Annual Meeting: Hematologic Malignancies, experts, including Logan, further discussed the new and best strategies for managing patients with ALL.

Transcription:

0:08 | The management of adults with ALL has become a bit more complex but thankfully more successful due to the availability of agents such as blinatumomab, inotuzumab, and we now have CAR T cells that are approved for adults of all age groups. We are now seeing that some of these agents are being moved to frontline therapy, in particular, blinatumomab, which is actually FDA approved for the management of minimal residual disease [MRD]-positive ALL.

0:40 | The NCCN guidelines now specify that it is an appropriate therapy for patients that have MRD positivity to get blinatumomab and then conventionally followed by an allogeneic stem cell transplant. There are potentially some patients that could remain in a long term remission after blinatumomab without transplant, but we currently are not able to prospectively identify those patients. The plan is generally to do blinatumomab followed by an allogeneic transplant. Then as far as the remainder of consolidation therapy for patients who achieved the milestone of MRD negativity after induction, or at least early in the course of therapy after initial consolidation, there are a few different options, including continuing multi-agent chemotherapy based on what protocol they're on.

1:24 | Their protocol might be a pediatric inspired regimen, such as the CALGB 10403 regimen if they're in the adolescent or young adult group, or it might be hyper-CVAD depending on what institution they're being treated at. Another option per the NCCN guidelines would be to use blinatumomab as consolidation, even for patients who have achieved MRD negativity. That's based on some studies that have already demonstrated that blinatumomab is safe therapy after multi-agent chemotherapy, and is likely associated with long term remissions in that setting.