Both the concept of an antibody-drug conjugate combined with less-intensive chemotherapy and the actual regimen used in this study are exciting, according to Nikolai Podoltsev, MD, PhD, Assistant Professor, Division of Hematology, Yale University Medical Center, New Haven, Connecticut. “This has great potential as upfront treatment for Philadelphia chromosome–negative ALL [in those] aged 60 and older,” he declared.

Other Ongoing Studies

Inotuzumab ozogamicin monotherapy is being studied in the phase III INNOVATE trial in relapsed/refractory ALL, noted Dr. Podoltsev. “It is intuitive to bring upfront therapy we use in the relapsed/refractory setting. Response rates of more than 90% are promising,” he said.

In this study, 4 of 35 evaluable patients developed veno-occlusive disease. “Veno-occlusive disease is the biggest concern in both transplanted and nontransplanted patients,” noted Dr. Podoltsev.

“Philadelphia chromosome–negative ALL is difficult to treat in older patients. Very few older adults are cured, and most are on clinical trials. Younger ALL patients aged 40 to 50 are treated with pediatric-inspired regimens. Older (i.e., over age 40) [patients] are treated with hyper-CVAD or the CALGB 911 protocol,” he explained.

The ECOG 1910 phase III trial is evaluating blinatumomab (Blincyto) as part of therapy in Philadelphia chromosome–negative ALL patients between the ages of 30 and 70, and this may turn out to be a useful regimen combined with chemotherapy, he added.

“The results of Dr. Jabbour’s trial in patients aged 60 to 79 years are impressive. Some patients at Yale would get this regimen,” Dr. Podoltsev said. ■

Disclosure: Dr. Podoltsev reported no potential conflicts of interest.