Dr. Jabbour on Emerging Subsets in ALL

Elias Jabbour, MD, an associate professor in the Department of Leukemia at The University of Texas MD Anderson Cancer Center, discusses recent treatment advances and emerging subsets in acute lymphoblastic leukemia (ALL). Jabbour shared this insight during an interview at the 2016 OncLive State of the Science Summit on Hematologic Malignancies.

A lot of progress is being made in the field of ALL, said Jabbour. Though he admits the field may not be up to par with pediatric leukemia, there are many advances occurring.

For example, new subsets are being diagnosed. The Philadelphia-type of ALL is a new entity, Jabbour says, which is often associated with worse outcomes. Though tyrosine kinase inhibitors added to chemotherapy may improve the outcome of these patients, it still remains to be proven.

Tyrosine kinase inhibitors are available for patients with Philadelphia-positive ALL, one of them being the potent inhibitor ponatinib (Iclusig). When it is added to chemotherapy, the combination is associated with a cure rate of 80%, Jabbour explains.

Blinatumomab (Blincyto) has good activity as a single agent in the relapsed setting, he adds, and elicits activity of 40% responses. The FDA granted an accelerated approval to the monoclonal antibody blinatumomab in December 2014. Blinatumomab was later approved for pediatric patients in the same setting in July 2016.

Researchers are currently trying to combine blinatumomab and a TKI—mainly ponatinib—to see if chemotherapy can be replaced. This would help cure patients without aggressive treatment, he says.