Treatment landscape ‘exciting’ for patients with ALL
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Significant progress has been made in treatment and improving survival outcomes across all subtypes of acute lymphoblastic leukemia, according to a speaker at Chemotherapy Foundation Symposium.
“There are a lot of exciting things happening right now in [ALL] ... there will be a cure for these patients in our lifetime,” Elias Jabbour, MD, professor in the department of leukemia at The University of Texas MD Anderson Cancer Center, said during a presentation. “Five-year survival is 60% for adult patients, we are still lagging behind pediatric ALL, but progress has been made and within the next 10 years, we will see further improvements in outcomes for these patients because we have the tools to cure ALL.”
Jabbour provided an overview of the most recent advancements in treatment for ALL, including the addition of tyrosine kinase inhibitors to chemotherapy in Philadelphia chromosome-positive ALL, the addition of rituximab (Rituxan; Genentech, Biogen) to chemotherapy in pre-B-cell ALL, CAR T-cell therapy, and the potential benefit of adding CD19 and CD22 antibodies to chemotherapy in salvage and front-line ALL.
“Most patients with ALL will relapse and there is still an unmet need for patients who relapse, but newer therapies are rapidly evolving,” Jabbour said. “Initially, patients who relapsed were treated with transplantation, but these patients can still have poor outcomes.”
There are now several approved treatment options for ALL.
“We have seen the best outcomes in clinical trials when using these agents in a sequential way and in combination,” he said. “CAR T-cell therapy for ALL is what allogeneic stem cell transplant was in 1980 — a great beginning. We are working on better CAR T-cell therapy designs with dual CAR T-cells targeting CD19, CD22 and CD20. Hopefully, one day CAR T-cell therapy will replace transplantations. Both antibody and CAR T-cell therapies are outstanding but are not mutually exclusive, rather they complement each other.”
The future of ALL therapy will involve less chemotherapy and shorter durations of treatment, as well as combination regimens and CAR T-cell therapies in sequence for minimal residual disease, Jabbour said.
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Jabbour E. Practice-changing updates in B-cell ALL. Presented at: 39th Annual Chemotherapy Foundation Symposium: Innovative Cancer Therapy for Tomorrow; Nov. 3-5, 2021.
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