Journal article
Treatment-free remission in nontransplanted patients with Philadelphia chromosome-positive acute lymphoblastic leukemia
Cancer, Vol.131(5), pp.e35773-n/a
03/01/2025
DOI: 10.1002/cncr.35773
PMID: 39980368
Abstract
Background: The BCR::ABL1 tyrosine kinase inhibitors (TKIs) have significantly improved the outcomes of patients with Philadelphia chromosome (Ph)-positive acute lymphoblastic leukemia (ALL). However, the optimal duration of TKI therapy in patients who achieve a complete molecular response (CMR; undetectable BCR::ABL1 transcripts) and who do not undergo allogeneic stem cell transplantation (allo-SCT) remains undefined. Methods: The authors conducted a retrospective analysis of patients with Ph-positive ALL in first complete remission who achieved a CMR and discontinued TKI therapy, most commonly due to treatment-related side effects. Results: In total, 14 patients were identified. The regimen of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with high-dose methotrexate and cytarabine was the primary backbone chemotherapy and was received by 12 patients (86%) combined with either imatinib (14%), dasatinib (43%), or ponatinib (29%) during induction. Two patients received blinatumomab and ponatinib. The median duration of TKI therapy was 60 months. The median CMR duration before TKI discontinuation was 46.1 months (range, 2.7-121.3 months). After a median follow-up of 42.5 months from TKI discontinuation, three patients (21%) experienced relapse (two molecular, one morphologic), whereas 11 patients (79%) maintained treatment-free remission. The median time to relapse was 6.4 months (range, 4-16 months), and two of three relapsed patients regained CMR after resuming TKI therapy. Importantly, none of the six patients with a CMR duration >48 months before TKI discontinuation relapsed. Conclusions: The current findings suggest that TKI discontinuation may be safe for highly selected patients with Ph-positive ALL in first complete remission who maintain CMR for at least 48 months. Larger studies are needed to confirm these findings.
Details
- Title: Subtitle
- Treatment-free remission in nontransplanted patients with Philadelphia chromosome-positive acute lymphoblastic leukemia
- Creators
- Eitan Kugler - The University of Texas MD Anderson Cancer CenterHagop Kantarjian - The University of Texas MD Anderson Cancer CenterElias Jabbour - The University of Texas MD Anderson Cancer CenterNiranjan Khaire - The University of Texas MD Anderson Cancer CenterNicholas J. Short - The University of Texas MD Anderson Cancer CenterTapan M. Kadia - The University of Texas MD Anderson Cancer CenterFadi G. Haddad - The University of Texas MD Anderson Cancer CenterKoji Sasaki - The University of Texas MD Anderson Cancer CenterRashmi Kanagal Shamanna - Univ Texas MD Anderson Canc Ctr, Dept Hematopathol, Houston, TX USARebecca Garris - The University of Texas MD Anderson Cancer CenterFarhad Ravandi - The University of Texas MD Anderson Cancer CenterNitin Jain - The University of Texas MD Anderson Cancer Center
- Resource Type
- Journal article
- Publication Details
- Cancer, Vol.131(5), pp.e35773-n/a
- DOI
- 10.1002/cncr.35773
- PMID
- 39980368
- ISSN
- 0008-543X
- eISSN
- 1097-0142
- Publisher
- Wiley
- Number of pages
- 9
- Grant note
- Leukemia and Lymphoma Society Career Development Award P30 CA016672 / MD Anderson Cancer Center NIH/NCI Cancer Center Support Grant
- Language
- English
- Date published
- 03/01/2025
- Academic Unit
- Internal Medicine
- Record Identifier
- 9985237503402771
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