Dr. Vusirikala on Hyper-CVAD Plus Ponatinib in Philadelphia Chromosome-Positive ALL

Madhuri Vusirikala, MD, professor of internal medicine in the Division of Hematology/Oncology at the Harold C. Simmons Comprehensive Cancer Center of UT Southwestern Medical Center, discusses the benefit of hyperfractionated cyclophosphamide, vincristine, doxorubicin hydrochloride, and dexamethasone (hyper-CVAD) and the multitargeted TKI ponatinib (Iclusig) in patients with Philadelphia chromosome—positive ALL.

At the 2019 ASH Annual Meeting, investigators from the University of Texas MD Anderson Cancer Center presented updated data on a trial examining the combination of hyper-CVAD and ponatinib in patients with Philadelphia chromosome—positive ALL, says Vusirikala.

These data continued to demonstrate that treatment with the combination have leads to much better response rates. Additionally, investigators were able to avoid transplant in this subgroup of high-risk patients. Prior to the introduction of TKIs, patients with Philadelphia chromosome—positive ALL were always recommended to undergo an allogeneic transplant because that was the only potentially curative approach, explains Vusirikala. Now, with the addition of TKIs, improved responses and cures without transplant have been reported in this patient population.

In fact, it appears that patients who are treated with ponatinib and hyper-CVAD, who go on to receive transplant, have a worse prognosis than those who continue on ponatinib without transplant, concludes Vusirikala.