Talha Badar, Associate Professor of Medicine at Mayo Clinic College of Medicine and Science, Hematology/Oncology Specialist at Mayo Clinic, shared a post on X:
“Weekend review in the midst of FIFA26 World Cup fever
While the world is debating FIFA rules, referee bias, and game-changing decisions, another frontline playbook has been evolving in Ph+ ALL: potent TKI + early blinatumomab + MRD-guided transplant decisions.
D-ALBA established proof-of-concept for chemo-free therapy with dasatinib – blinatumomab.
Final analysis:
- 53-mo DFS: 75.8%
- 53-mo OS: 80.7%
- 53-mo EFS: 74.6%
- No events among early molecular responders.
Ref: Foà et al, JCO 2023.
Ponatinib + blinatumomab builds on this with a more potent TKI and T315I coverage.
Phase II data:
- CMR in newly diagnosed evaluable pts: 87%
At median follow-up of 29 months, 3-year EFS was 78% and 3-year OS was 88%; 13% relapsed, median time to relapse 18 months. Relapses were predominantly extramedullary (CNS n=5, peritoneum/nodes n=1), and CD19 expression remained high at relapse in all cases.
Ref: Jabbour et al, Lancet Haematol 2023. Short et al Journal of Hematol Onc 2025.
Randomized phase III data support choosing potent TKI early.
PhALLCON: ponatinib vs imatinib + reduced-intensity chemotherapy
- MRD-negative CR: 34.4% vs 16.7% P = .002
- EFS: NR vs 29 mo, HR 0.65
- PFS: 20.0 vs 7.9 mo, HR 0.58.
Ref: Jabbour et al, JAMA 2024.
GIMEMA ALL2820 further supports chemo-sparing therapy.
Ponatinib + blinatumomab vs imatinib + chemotherapy:
- CHR day 70: 94.3% vs 79.4%
- Molecular response: 70.9% vs 48.7%
- EFS/OS: 90%/94% vs 74%/77%.
Ref: GIMEMA ALL2820, ASH 2025.
MRD kinetics now drive the transplant discussion.
COMMAND real-world data:
- 63.7% achieved CMR at 3 months
- In CMR patients, allo-HCT improved RFS: 123.1 vs 30.3 mo
- OS was not significantly different: 129.2 vs 149.3 mo, p = 0.07.
Ref: Mohty/Badar et al, Leuk Lymphoma 2026.
Practical 2026 algorithm for Ph+ ALL
- Use ponatinib-based therapy when vascular risk is acceptable
- Use dasatinib-based chemo-free therapy when ponatinib is not ideal
- Add blinatumomab early
- Let CMR/MRD kinetics determine allo-HCT need
- Reserve chemo for high burden, unstable disease, or access limitations.
Other articles featuring Talha Badar on OncoDaily.