Chemo-Free Induction/Consolidation With Dasatinib and Blinatumomab Shows Long-Term Responses for Adult Patients With Philadelphia-Positive ALL

Findings from the Final Analysis of the D-ALBA Trial 

Chemotherapy-free induction and consolidation with targeted strategy dasatinib and immunotherapy blinatumomab prompted durable long-term hematologic and molecular responses among adult patients with Philadelphia-positive (Ph+) acute lymphoblastic leukemia (ALL), according to the final analysis of the D-ALBA trial. 

The D-ALBA trial included 63 eligible adult patients of various ages with ALL, who were administered this regimen. At a median follow-up of 53 months, the disease-free survival was 75.8%, the overall survival was 80.7%, and the event-free survival was 74.6%. Among patients who responded to the treatment early, no events were recorded. Conversely, patients with IKZF1plus gene deletion experienced a significantly worse outcome. 

A total of 29 patients (93.1% of whom had a molecular response defined as a complete molecular response or positive non-quantifiable after dasatinib/blinatumomab treatment) did not receive chemotherapy or transplant, and continued treatment solely with a tyrosine kinase inhibitor. A total of 28 patients retained consistent long-term complete hematologic response. In the first complete hematologic response, an allogeneic transplant was executed, particularly among patients with persistent minimal residual disease. The study authors noted that 83.3% of patients were in continuous complete hematologic response. 

Transplant-related mortality occurred in 12.5% of patients who were transplanted in the first complete hematologic response, and 13.7% of patients overall. Relapses were experienced by 9 patients, and 6 deaths were recorded. Additionally, ABL1 mutations were discovered in 7 cases. 

Robin Foà, MD, Sapienza University, Rome, Italy, and coauthors 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 Ph+ ALL, paving the way for a new era in the management of these patients."

Source: 

Foà R, Bassan R, Elia L, et al. Long-term results of the dasatinib-blinatumomab protocol for adult Philadelphia-positive ALL. J Clin Oncol. Published online: December 21, 2023. doi: 10.1200/JCO.23.01075