Robert Hromas, MD, of the University of Florida College of Medicine, Gainesville, who moderated a press briefing, commented that the finding of benefit with rituximab “resolves a long-standing controversy” with this cancer. “These results are exciting for those of us who treat leukemia,” he commented.

The ASCO Post asked Timothy A. Graubert, MD, Professor of Medicine, Harvard Medical School, and Hagler Family Chair in Oncology and Director of Hematologic Malignancies at Massachusetts General Hospital Cancer Center, Boston, for his thoughts on these findings. “Adult ALL in general is a difficult disease. We have not as much success in adults as we have had in treating children, so this strategy represents an advance,” he said. “We now have, for the first time, prospective evidence showing that rituximab is beneficial in this disease. One could argue that this study could be
practice-changing.”

Fewer Allergic Reactions

Dr. Graubert was particularly intrigued by the occurrence of fewer hypersensitivity reactions in rituximab-treated patients. These allergic reactions may lead to discontinuation of asparaginase.

“Allergic reactions were lower with rituximab, and it’s perhaps not surprising as to how this could happen,” he said. Rituximab depletes CD20-positive B cells but also normal B cells, which produce antibodies to mediate allergic reactions, he explained.

“It’s conceivable that the positive results of the study are explained in part by this phenomenon. The open question is whether rituximab allowed these patients to receive greater cumulative exposure to asparaginase,” he added. “This needs to be analyzed and answered, but either way, the study was positive.” ■

Disclosure: Dr. Hromas has an uncompensated and nonequity advisory position with Cloud Pharmaceuticals. Dr. Graubert reported no potential conflicts of interest.