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The evolving role of chemotherapy and hematopoietic cell transplants in Ph-positive acute lymphoblastic leukemia in adults

Bone Marrow Transplantation volume 52, pages 1592–1598 (2017)Cite this article

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Abstract

The introduction of the tyrosine kinase inhibitors (TKI) into the treatment of patients with Ph or BCR-ABL1-positive acute lymphoblastic leukemia has revolutionized the treatment of this poor prognosis acute leukemia. The combination of TKI with chemotherapy has improved response rates and allowed more patients to proceed to allogeneic hematopoietic cell transplant (alloHCT). Older patients have excellent responses to TKI and corticosteroids or in combination with minimal chemotherapy. This raises the question as to whether patients require full-intensity chemotherapy with TKI to achieve molecular remissions. The pediatricians have proposed that cure is achievable without alloHCT in children. These results have suggested that many patients may not require traditional chemotherapy in addition to TKI to achieve remission, and that patients who achieve a negative minimal residual disease state may not require alloHCT. The data in support of these questions is presented here and a suggested future clinical trial design based on these data is proposed.

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Acknowledgements

We thank Ms Denise Chase for excellent assistance in transcription and preparation of the manuscript. Amgen had no role in the design of this review or the decision to publish it.

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Authors and Affiliations

  1. Division of Hematology, Mayo Clinic, Rochester, MN, USA

    M R Litzow

  2. University College, London, UK

    A K Fielding & A H Goldstone

  3. University of Pennsylvania, Philadelphia, PA, USA

    S M Luger

  4. Montefiore Medical Center, Bronx, NY, USA

    E Paietta

  5. Rambam Healthcare Campus, Haifa, Israel

    Y Ofran

  6. Shaare Zedek Medical Center, Jerusalem, Israel

    J M Rowe

  7. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    M S Tallman

  8. University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    H M Lazarus

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Correspondence to M R Litzow.

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Competing interests

MRL has received research funding support from Amgen. AF has served on Amgen advisory boards. HML has served as a speaker for Bristol Myers Squibb and as a speaker for Amgen and on Amgen advisory boards. SML has received honoraria from Novartis and research funding from Amgen and Ariad. The remaining authors declare no conflict of interest.

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Litzow, M., Fielding, A., Luger, S. et al. The evolving role of chemotherapy and hematopoietic cell transplants in Ph-positive acute lymphoblastic leukemia in adults. Bone Marrow Transplant 52, 1592–1598 (2017). https://doi.org/10.1038/bmt.2017.110

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