(HealthDay)—Chemotherapy-free induction and consolidation first-line treatment with dasatinib and blinatumomab is associated with a high incidence of molecular response and survival in adults with Philadelphia chromosome (Ph)-positive acute lymphoblastic leukemia (ALL), according to a study published in the Oct. 22 issue of the New England Journal of Medicine.
Robin Foà, M.D., from Sapienza University of Rome, and colleagues conducted a single-group phase 2 trial of first-line therapy in newly diagnosed Ph-positive ALL. Sixty-three adults received dasatinib plus glucocorticoids followed by two cycles of blinatumomab.
The researchers found that 98 percent of patients had complete remission. Twenty-nine percent of the patients had a molecular response at the end of dasatinib induction (day 85), and this increased to 60 percent after two cycles of blinatumomab; a further increase in the percentage of patients with a molecular response occurred after additional blinatumomab cycles. Overall survival was 95 percent and disease-free survival was 88 percent at a median follow-up of 18 months. Patients who had an IKZF1 deletion plus additional genetic aberrations had lower disease-free survival. In six patients who had increased minimal residual disease during induction therapy, ABL1 mutations were detected; all were cleared by blinatumomab. There were six relapses and 21 adverse events of grade 3 or higher. Twenty-four patients received a stem cell allograft and one death was associated with transplantation.
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