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If a pill plus immunotherapy makes the leukaemia undetectable, can most adults safely skip a bone-marrow transplant?
If a tyrosine kinase inhibitor plus blinatumomab renders Philadelphia chromosome-positive acute lymphoblastic leukaemia undetectable, this idea asks whether most adults can safely forgo allogeneic transplant in first remission. The hypothesis is that patients in complete molecular remission have equivalent overall survival with TKI maintenance and MRD surveillance as with transplant. The rationale is that deaths caused by the transplant itself may exceed the relapse risk it prevents, and that blinatumomab and ponatinib rescue many relapses; in D-ALBA (GIMEMA LAL2116) around half of patients were not transplanted and did well. A trial would randomise MRD-negative patients to transplant or to TKI maintenance with BCR::ABL1 PCR and pre-emptive blinatumomab; it is being tested at scale.
One of the most cited trial reports Europe PMC returns for Blinatumomab in Acute lymphoblastic leukaemia, so it is a natural first reading for anyone weighing the idea it is linked from. The record was linked automatically by title and abstract; read the abstract above and the paper itself before relying on any figure.
One of the most cited trial reports Europe PMC returns for Blinatumomab in Acute lymphoblastic leukaemia, so it is a natural first reading for anyone weighing the idea it is linked from. The record was linked automatically by title and abstract; read the abstract above and the paper itself before relying on any figure.
Ponatinib is the drug for T315I-mutated disease and for patients who have failed several inhibitors, including in accelerated and blast phase as a bridge to transplant. Cardiovascular risk must be managed actively.
Shares D-ALBA (GIMEMA LAL2116), Ph-positive ALL, Ponatinib, Dasatinib.
Shares Ph-positive ALL, Ponatinib, MRD-negative complete remission, Philadelphia chromosome-positive acute lymphoblastic leukaemia in children (Ph-positive ALL).
Shares Safety and activity of blinatumomab for adult patients with relapsed or refractory B-precursor acute lymphoblastic leukaemia: a multicentre, single-arm, phase 2 study, Blinatumomab versus Chemotherapy for Advanced Acute Lymphoblastic Leukemia, Blinatumomab, Acute lymphoblastic leukaemia.
Shares Blinatumomab versus Chemotherapy for Advanced Acute Lymphoblastic Leukemia, Blinatumomab, Acute lymphoblastic leukaemia.
Shares MRD-negative complete remission, NGS-based MRD (clonoSEQ and molecular MRD), Allogeneic stem cell transplantation.
Shares Ponatinib, Dasatinib, Philadelphia chromosome-positive acute lymphoblastic leukaemia in children (Ph-positive ALL), Blinatumomab.
Shares Ponatinib, Dasatinib, Philadelphia chromosome-positive acute lymphoblastic leukaemia in children (Ph-positive ALL), Blinatumomab.
Shares Ponatinib, Dasatinib, Philadelphia chromosome-positive acute lymphoblastic leukaemia in children (Ph-positive ALL), Acute lymphoblastic leukaemia.