614. Acute Lymphoblastic Leukemias: Therapies, Excluding Transplantation and Cellular Immunotherapies I
Inge M. Van Der Sluis, Paola De Lorenzo, Rishi Sury Kotecha, et al.
Blinatumomab plus Interfant06 backbone was very well tolerated. The authors speak of promising efficacy in terms of a high rate of complete MRD response and short-term event free survival. In historical controls, relapses are frequent and early in therapy. However, the low relapse rate after blinatumomab is remarkable, even if a longer follow-up period is yet missing. Based on the study results, blinatumomab will be introduced in the next Interfant21 protocol for all infants with newly diagnosed KMT2A-r-ALL.
362 ASH denotes this abstract as clinically relevant
Nicola Goekbuget, Matthias Stelljes, Andreas Viardot,et al.
This ongoing study presents promising preliminary results, including for those aged 45-55. This means that even adults beyond the variable AYA definitions can benefit from a pediatric protocol with an intensive and individualized ASP therapy. High rates of HemCR were found in almost all subgroups. The MolCR rates ranged from 41-74% and a significant proportion of the patients remained MRD low positive. The authors, therefore, emphasize the need for a detailed MRD classification.
A high proportion of patients were treated with MRD-based targeted therapy. For MolFail, the response to blinatumomab was lower compared to previous studies, and for MolFail T-ALL patients, the response to nelarabine was only 18%. On the other hand, the OS of MolFail patients with the combination of targeted therapy and SCT was promising. For the study authors, the SCT is therefore still a key component: It contributes to improved results, although the overall proportion of SCT was lower than in previous GMALL studies.
Patrick A. Brown, Lingyun Ji, Xinxin Xu, et al.
The blinatumomab arm was superior to the standard chemotherapy arm for patients with BM ± EM relapse. Thus, according to the study authors, blinatumomab is the new standard therapy for these patients. The blinatumomab arm, on the other hand, was not superior in IEM relapse. Better treatments are urgently needed for the subgroup of CNS relapse patients because a strikingly high rate of relapse has been observed in both arms.
Sujith Samarasinghe, Ajay Vora, Nicholas John Goulden, et al.
It is safe for low-risk patients to de-escalate therapy. High-risk patients, especially those with high-risk cytogenetics, can benefit from intensified therapy. This is the long term result of UKALL 2003.
Eleni Argyriadi, Ingo G. Steffen, Guenter Henze, et al.
Treatment delays did not affect the outcome. However, deviations from the protocol - a relevant part would be avoidable - did not significantly influence the remission rates, but they were significantly associated with inferior DFS. Strict adherence to the protocol should lead to improved results. Deviations from the protocol have a prognostic influence, especially in patients with late relapse with generally more chemosensitive diseases and a better prognosis.
Clare J Rowntree, Amy A Kirkwood, Laura Clifton-Hadley, et al.
ABP is an independent negative prognostic factor. Patients with T ALL and ABP were more than twice as likely to relapse. This is an indication to classify them as high-risk patients in future studies. Nelarabine according to ABP status does not appear to be of any benefit.