Dasatinib-Blinatumomab for Ph-Positive Acute Lymphoblastic Leukemia in Adults.
Adult
Aged
Aged, 80 and over
Allografts
Antibodies, Bispecific
/ administration & dosage
Antineoplastic Combined Chemotherapy Protocols
/ adverse effects
Consolidation Chemotherapy
Dasatinib
/ administration & dosage
Female
Hematopoietic Stem Cell Transplantation
/ adverse effects
Humans
Induction Chemotherapy
Male
Middle Aged
Mutation
Philadelphia Chromosome
Precursor Cell Lymphoblastic Leukemia-Lymphoma
/ drug therapy
Remission Induction
Survival Analysis
Treatment Outcome
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
22 10 2020
22 10 2020
Historique:
entrez:
21
10
2020
pubmed:
22
10
2020
medline:
6
11
2020
Statut:
ppublish
Résumé
Outcomes in patients with Philadelphia chromosome (Ph)-positive acute lymphoblastic leukemia (ALL) have improved with the use of tyrosine kinase inhibitors. Molecular remission is a primary goal of treatment. We conducted a phase 2 single-group trial of first-line therapy in adults with newly diagnosed Ph-positive ALL (with no upper age limit). Dasatinib plus glucocorticoids were administered, followed by two cycles of blinatumomab. The primary end point was a sustained molecular response in the bone marrow after this treatment. Of the 63 patients (median age, 54 years; range, 24 to 82) who were enrolled, a complete remission was observed in 98%. At the end of dasatinib induction therapy (day 85), 29% of the patients had a molecular response, and this percentage increased to 60% after two cycles of blinatumomab; the percentage of patients with a molecular response increased further after additional blinatumomab cycles. At a median follow-up of 18 months, overall survival was 95% and disease-free survival was 88%; disease-free survival was lower among patients who had an A chemotherapy-free induction and consolidation first-line treatment with dasatinib and blinatumomab that was based on a targeted and immunotherapeutic strategy was associated with high incidences of molecular response and survival and few toxic effects of grade 3 or higher in adults with Ph-positive ALL. (Funded by Associazione Italiana per la Ricerca sul Cancro and others; GIMEMA LAL2116 D-ALBA EudraCT number, 2016-001083-11; ClinicalTrials.gov number, NCT02744768.).
Sections du résumé
BACKGROUND
Outcomes in patients with Philadelphia chromosome (Ph)-positive acute lymphoblastic leukemia (ALL) have improved with the use of tyrosine kinase inhibitors. Molecular remission is a primary goal of treatment.
METHODS
We conducted a phase 2 single-group trial of first-line therapy in adults with newly diagnosed Ph-positive ALL (with no upper age limit). Dasatinib plus glucocorticoids were administered, followed by two cycles of blinatumomab. The primary end point was a sustained molecular response in the bone marrow after this treatment.
RESULTS
Of the 63 patients (median age, 54 years; range, 24 to 82) who were enrolled, a complete remission was observed in 98%. At the end of dasatinib induction therapy (day 85), 29% of the patients had a molecular response, and this percentage increased to 60% after two cycles of blinatumomab; the percentage of patients with a molecular response increased further after additional blinatumomab cycles. At a median follow-up of 18 months, overall survival was 95% and disease-free survival was 88%; disease-free survival was lower among patients who had an
CONCLUSIONS
A chemotherapy-free induction and consolidation first-line treatment with dasatinib and blinatumomab that was based on a targeted and immunotherapeutic strategy was associated with high incidences of molecular response and survival and few toxic effects of grade 3 or higher in adults with Ph-positive ALL. (Funded by Associazione Italiana per la Ricerca sul Cancro and others; GIMEMA LAL2116 D-ALBA EudraCT number, 2016-001083-11; ClinicalTrials.gov number, NCT02744768.).
Identifiants
pubmed: 33085860
doi: 10.1056/NEJMoa2016272
doi:
Substances chimiques
Antibodies, Bispecific
0
blinatumomab
4FR53SIF3A
Dasatinib
RBZ1571X5H
Banques de données
EudraCT
['2016-001083-11']
ClinicalTrials.gov
['NCT02744768']
Types de publication
Clinical Trial, Phase II
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1613-1623Investigateurs
Renato Bassan
(R)
Felicetto Ferrara
(F)
Robin Foà
(R)
Sabina Chiaretti
(S)
Alessandro Rambaldi
(A)
Gianluca Gaidano
(G)
Francesco Fabbiano
(F)
Nicola Di Bartolomeo
(N)
Massimiliano Bonifacio
(M)
Nicola Fracchiolla
(N)
Francesco Albano
(F)
Brunangelo Falini
(B)
Giovanna Rege Cambrin
(GR)
Nicola Di Renzo
(N)
Alessandro Cignetti
(A)
Francesco Di Raimondo
(F)
Alberto Bosi
(A)
Bruno Martino
(B)
Simona Sica
(S)
Monica Crugnola
(M)
Fabio Ciceri
(F)
Erika Borlenghi
(E)
Michela Rondoni
(M)
Matteo Della Porta
(M)
Catello Califano
(C)
Laura Cudillo
(L)
Adriano Venditti
(A)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 Massachusetts Medical Society.