Clinical Advances in Hematology & OncologyCan We Cure Ph+ ALL Without Chemotherapy or Transplant?

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Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) management has significantly advanced with the introduction of tyrosine kinase inhibitors (TKIs) and immunotherapy. This Q&A with Dr. Robin Foà out of the Sapienza University of Rome, discusses the evolution of treatment strategies, from chemotherapy-intensive regimens to chemotherapy-free approaches, highlighting improved outcomes and reduced toxicity for patients across age groups.

Key Points:

• Ph+ ALL accounts for 25-30% of adult ALL cases, increasing in frequency with age.
• TKIs, initially imatinib and later dasatinib and ponatinib, have dramatically improved Ph+ ALL outcomes.
• The GIMEMA study group pioneered a chemotherapy-free induction using TKIs plus corticosteroids, achieving 94-100% complete response rates.
• Recent studies combine TKIs with immunotherapy (blinatumomab), showing high molecular response rates and favorable survival outcomes.
• The ALBA study reported 75-80% progression-free, overall, and event-free survival rates at 4-year follow-up without chemotherapy or transplant for many patients.
• Rapid diagnostic work-up and measurable residual disease (MRD) monitoring are crucial for treatment decisions.
• Chemotherapy-free regimens significantly reduce side effects and hospitalization needs compared to traditional chemotherapy.

“Let me make it very clear: all patients with Ph+ ALL should have access to a TKI. The first problem lies in diagnosing them.”
– Robin Foà, MD, Emeritus Professor of Hematology, Sapienza University of Rome

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