Talha Badar, Hematology/Oncology Specialist at Mayo Clinic, shared a post on X:
“Key abstracts to watch in acute lymphoblastic leukemia
Overall Takeaways – ASH 2025 ALL Landscape
- Rapid movement toward chemo-free or chemo-lite regimens, especially in Ph+ ALL.
- TKI + immunotherapy (blina / InO) emerging as new standard-contenders.
- CAR-T earlier in therapy (CR1 consolidation and frontline).
- Expanding roles for bispecifics and venetoclax-based combinations in R/R ALL.
- MRD (especially NGS-MRD) is central to future risk-adapted strategies.
1. Genomics and Risk Stratification
Abstract ID 31 – ECOG-ACRIN E1910
New genomic subsets identified → refine MRD-guided risk stratification; genomic features predicting treatment outcome in adult ALL.
Abstract ID 551
Comprehensive comparison of PCR vs NGS MRD detection. NGS identifies deeper MRD and correlates with transcript type and outcomes → supports expanded NGS-based MRD use in Ph+ ALL.
3. Immunotherapy-Driven Chemo-Lite Approaches in Ph– ALL
ID 643 – Blinatumomab consolidation (B-QUEST trial)
In high-risk Ph– ALL, blinatumomab consolidation shows sustained benefit → supports reduced-chemotherapy / immunotherapy-first strategies.
4. Venetoclax Combinations in R/R ALL
ID 645 – VEN + InO
VEN + Inotuzumab in R/R ALL shows promising activity in Phase I → a potential targeted backbone for chemo-lite salvage regimens.
ID 647 – MK-1045 (CD19xCD3)
Novel T-cell engager in R/R B-ALL with updated efficacy/safety → emerging alternative to blinatumomab with potent activity in heavily pre-treated patients.
6. CAR-T for High-Risk and Post-CAR Relapse
ID 646
Humanized CD19 CAR-T demonstrates activity in high-risk disease and post-CAR relapse → improving durability and re-treatment feasibility.
7. Chemo-Free Frontline Ph+ ALL
ID 439 – GIMEMA ALL2820 (Ponatinib + Blina vs Imatinib + Chemo)
Chemo-free ponatinib + blinatumomab arm shows strong early results → continues momentum toward TKI + BiTE frontline therapy.
8. Chemo-Free Frontline Ph+ ALL
ID 441 – TKI + InO in newly diagnosed Ph+ ALL
Phase II analysis: deep molecular remissions with minimal chemotherapy → another step toward chemo-sparing frontline approaches.
9. Low-Intensity Regimens for Older Adults
ID 444 – InO → Blina (A041703)
Long-term follow-up: durable remissions in older Ph– CD22+ B-ALL with minimal chemotherapy → highly tolerable chemo-lite pathway.
10. CAR-T as Consolidation in CR1
ID 443
CD19 CAR-T as first-remission consolidation in older adults is feasible, safe, and achieves durable MRD– responses → may replace alloHCT for select patients.”
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