As reported in the Journal of Clinical Oncology by Foà et al, long-term results of the Italian D-ALBA study have shown that a chemotherapy-free induction/consolidation regimen of dasatinib followed by blinatumomab maintained highly favorable outcomes in the front-line treatment of adult patients with Philadelphia chromosome–positive acute lymphoblastic leukemia (ALL).
Study Details and Key Findings
The study included 63 patients who received front-line induction and consolidation with dasatinib followed by blinatumomab. At a median follow-up of 53 months, 4-year rates of disease-free, overall, and event-free survival were 75.8%, 80.7%, and 74.6%, respectively, with no disease events being observed among patients with early molecular response.
Significantly poorer 4-year disease-free survival was observed among 11 patients with the IKZF1plus profile, ie, the co-occurrence of an IKZF1 deletion with deletions in CDKN2A, CDKN2B, PAX5, or PAR1 in the absence of ERG deletion (45.5%) vs 25 without an IKZF1 deletion (82.3%) and 13 with IKZF1-only deletions (74%; overall P = .029). Similar findings were seen for overall survival.
A total of 29 patients, including 27 in molecular response after dasatinib/blinatumomab, did not receive chemotherapy or undergo transplantation and continued treatment with only a tyrosine kinase inhibitor; of these, 28 remain in long-term complete hematologic response.
A total of 24 patients underwent allogeneic transplantation in first complete hematologic response (mostly patients with persistent measurable residual disease); of these, 24 (83.3%) remained in continuous complete hematologic response. Transplantation-related mortality was 12.5% among patients undergoing transplantation in first complete hematologic response and 13.7% overall.
Overall, nine relapses were reported, with ABL1 mutations being identified in seven cases.
The investigators concluded, “The final analysis of the D-ALBA study shows that a chemotherapy-free induction/consolidation regimen on the basis of a targeted strategy (dasatinib) and immunotherapy (blinatumomab) is effective in inducing durable long-term hematologic and molecular responses in adult [Philadelphia chromosome–positive] ALL, paving the way for a new era in the management of these patients.”
Robin Foà, MD, of the Department of Translational and Precision Medicine, Sapienza University of Rome, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
