Nitin Jain: Treatment-free remission in Ph+ ALL
Nitin Jain, Professor of Medicine at The University of Texas MD Anderson Cancer Center, shared a post on X about recent paper by Eitan Kugler et al., titled “Treatment-free remission in nontransplanted patients with Philadelphia chromosome-positive acute lymphoblastic leukemia” published on AACR Journals.
Authors: Eitan Kugler, Hagop Kantarjian, Elias Jabbour, Niranjan Khaire, Nicholas J. Short, Tapan M. Kadia, Fadi G. Haddad, Koji Sasaki, Rashmi Kanagal Shamanna, Rebecca Garris, Farhad Ravandi, Nitin Jain
“Treatment-free remission (TFR) in Ph+ ALL. A thread on our recent paper.
Unlike CML, no TFR concept exists in Ph+ ALL. This is more relevant nowadays when increasing numbers of patients are not allo-transplanted in CR1 for Ph+ ALL.
Question in clinic: How long should I continue TKI? Lifelong?
We did a retrospective chart review of the MDACC database and identified 14 patients with Ph+ ALL in CR1 who discontinued TKI (largely for toxicities) and had not undergone alloSCT.
We excluded patients who had brief treatment holds for side effects or for pregnancy related treatment holds.
Details of molecular response are shown below for the 14 patients.
Notably, of the 6 patients with CMR duration greater than 4 years, none relapsed. Conversely, 3 out of 8 patients with CMR duration less than 4 years had a molecular or clinical relapse.
As the patient numbers are very small, we do not recommend TFR in routine clinical practice, but this should be carefully studied as part of prospective trials.
If TFR is attempted, patients should be carefully selected (Ph+ ALL in CR1 with documented continuous CMR for at least 4-5 years) and closely monitored pre- and post-treatment discontinuation with BCR-ABL PCR and NGS MRD.
Much thanks to Drs. Kugler and Khaire for putting this together.”
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