The changing frontline treatment landscape for adult patients with acute lymphoblastic leukemia

In this video, Prof Dr Selina Luger, haemato-oncologist at the hospital of the University of Pennsylvania discusses the recent changes in the treatment landscape for adult patients with acute lymphoblastic leukemia (ALL). 

The standard first line treatment for patients with ALL consists of multi-agent chemotherapy. While the continuous optimization of these chemotherapy regimens has led to significant improvements in the survival of adult ALL patients, still about 30-50% of patients will eventually suffer a disease relapse. In recent years, several new treatment modalities have proven their worth in the treatment of relapsed/refractory (R/R) ALL patients. The most prominent of these therapies consist of inotuzumab ozogamicin, blinatumomab and CAR-T cell therapy.

The success of these agents in the R/R setting inspired clinicians to also evaluate their potential in earlier disease stages. In this respect, several studies have demonstrated a significant clinical benefit with the incorporation of blinatumomab in first line treatment regimens for adult ALL patients.1-3 For example, the randomised, phase III ECOG-ACRIN E1910 study recently showed that the addition of blinatumomab to consolidation chemotherapy significantly improved the overall survival of patients with BCR-ABL-negative ALL who achieved MRD negativity after consolidation chemotherapy (median OS not reached vs. 71.4 months).4 Importantly, the benefit obtained with blinatumomab in ECOG-ACRIN E1910 and other studies was also seen in older patients, a subgroup of patients who historically have a markedly worse outcome then their younger counterparts.

The results of these studies are reshaping the treatment paradigm of adult ALL patients, offering them less toxic treatment regimens with a higher likelihood for a durable disease remission.