Dr. Murthy on the Potential Benefits of Treatment De-Escalation in Ph+ B-ALL

Guru Subramanian Guru Murthy, MD, MS, assistant professor, Hematology, Medical Oncology, Medical College of Wisconsin, discusses the potential benefits of treatment de-escalation in Philadelphia chromosome (Ph)–positive B-cell acute lymphoblastic leukemia (B-ALL).

Ph-positive B-ALL is an aggressive subtype of B-ALL, Murthy says. Treatment for fit patients consists of intensive chemotherapy plus a TKI followed by bone marrow transplant. Patients who achieve remission and undergo transplant are often effectively cured of their disease, but they can receive maintenance therapy with a TKI, Murthy explains.

However, only a proportion of patients with Ph-positive B-ALL, many of whom are older, are fit enough to undergo this intensive treatment regimen, Murthy says. As such, evaluating a de-escalated approach could be beneficial for patients who cannot tolerate intensive chemotherapy.

Data have demonstrated that adding a TKI to chemotherapy improves rates of remission and outcomes among patients with Ph-positive B-ALL; however, equally robust data suggest that adding a TKI to steroids yields high rates of complete responses, Murthy says. Moreover, the latter approach is well tolerated and allows some patients to become eligible for transplant. With the addition of new agents like blinatumomab (Blincyto) to the armamentarium, de-escalation strategies under investigation are becoming more appealing treatment options, Murthy concludes.