In an interview with The ASCO Post, Hanno R. Hock, MD, PhD, Assistant Professor of Medicine at Harvard Medical School and Massachusetts General Hospital, highlighted the study’s “very nice response rate” and “encouraging data” while also noting that a pediatric-based treatment regimen in fit adults with acute lymphoblastic leukemia (ALL) is not entirely novel.

“DeAngelo and colleagues at Dana-Farber Cancer Institute published a trial in 2015 with 92 patients up to age 50, with equally good results,” said Dr. Hock. “However, this trial is larger and pushes the age limit even more (up to age 55).”

“Certainly, in Boston, similar pediatric regimens are already implemented. However, outside of major academic centers, there may be some hesitancy because the initial studies showed higher mortality in patients older than age 40. Thus, this study may be very useful if the data hold up,” he added.

Hanno R. Hock, MD, PhD

Regarding individualized asparaginase, Dr. Hock said the treatment may be useful and that dose reduction may help curb the toxicity. However, the data do not yet demonstrate whether reducing the dose may compromise outcome. “Given the overall good outcomes, that may not be the case, but I would like to see the data,” Dr. Hock commented.

Regarding the patients who experienced molecular failure, Dr. Hock said that a detailed examination of patient characteristics may provide some clues. If these cases harbor activated kinases (such as in mutated Ph+ ALL or Ph-like ALL), they may be targeted, he said.

“Overall, this is a very intriguing trial that corroborates the utility of pediatric regimens in adults,” Dr. Hock concluded. “I think the eventual analysis of the randomized components (intrathecal chemotherapy vs central nervous system irradiation; stem cell transplantation vs chemotherapy for patients with “high risk” who had great molecular responses) will be very interesting in the future.” 

DISCLOSURE: Dr. Hock reported no conflicts of interest.