Management of Philadelphia chromosome positive acute lymphoblastic leukemia in the current era.

Talha Badar, Hassan Alkhateeb, Mahmoud Aljurf, Mohamed A Kharfan-Dabaja

Current research in translational medicine 2023 Apr-Jun

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Before the advent of tyrosine kinase inhibitors (TKI) the outcome of Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia (ALL) was dismal. The TKI combination with induction regimens has greatly improved the long-term outcome of Ph+ ALL, specifically ponatinib a most potent TKI in combination with HyperCVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) chemotherapy has demonstrated 5 years overall survival up to 75%. Historically, allogeneic hematopoietic stem cell transplantation (allo-HSCT) used to be the only potential curative option, recent data suggest that patients who achieve complete molecular remission within 3 months of TKI based induction therapies can achieve comparable overall survival with or without allo-HSCT. Intensive cytotoxic chemotherapy may not be the desirable treatment option in elderly Ph+ ALL patients due to anticipated tolerance, recently in a phase II study, "chemotherapy free" combinations such as blinatumomab (bispecific anti-CD3 and anti-CD19 monoclonal antibody) with ponatinib in treatment naïve Ph+ ALL patients have shown a complete response rate of 95% and 2 years overall survival of 93%. In this review we have highlighted the evolving treatment landscape of Ph+ ALL and what to look for in future. Copyright © 2023 Elsevier Masson SAS. All rights reserved.

Citation

Talha Badar, Hassan Alkhateeb, Mahmoud Aljurf, Mohamed A Kharfan-Dabaja. Management of Philadelphia chromosome positive acute lymphoblastic leukemia in the current era. Current research in translational medicine. 2023 Apr-Jun;71(2):103392