Despite treatment advances, outcomes remain poor for adult
patients with R/R B-cell precursor ALL1,2
Median OS is <8 months with established immunotherapies3
Meta-analysis of OS with the current SOC in R/R B-cell precursor ALL4*
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*Data from a 2021 systematic literature review of efficacy and safety of treatments considered to be the SOC in adult patients with R/R ALL. Initial search for controlled, prospective phase 2 and above clinical trials began in June 2019 and was subsequently updated in November 2020. The following treatments were included in the search: blinatumomab, inotuzumab ozogamicin, TKIs (dasatinib, imatinib, ponatinib), and chemotherapy regimens (fludarabine-, cytarabine-, and alkylator-containing regimens).4
Response and survival rates are especially low for certain patients, including patients with primary refractory disease and those who relapsed following allo-SCT1,2†‡
†Data from a pooled analysis of adult patients with R/R ALL across 11 groups or sites in the United States and Europe. 2210 salvage records were included in total, with 1618 patients in first salvage, 372 patients in second salvage, and 160 patients in third or greater salvage.1
‡Data from a review of 245 patients with ALL treated at the University of Texas MD Anderson Cancer Center who received first salvage therapy following either primary treatment failure following induction or for relapsed ALL <12 months after initial therapy.2
Depth of response is critical for predicting outcomes in R/R B-cell precursor ALL5
MRD-negative status is associated with better median RFS in adult patients with R/R B-cell precursor ALL§
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From: Prognostic impact of incomplete hematologic count recovery and minimal residual disease on outcome in adult acute lymphoblastic leukemia at the time of second complete response. Saygin C, Papadantonakis N, Cassaday RD, et al. Leukemia & Lymphoma. 11 July 2017, reprinted by permission of the publisher Informa UK Limited trading as Taylor & Francis Ltd, http://www.tandfonline.com.
§Based on a retrospective analysis of 106 adult patients treated with SOC therapies for R/R ALL who achieved a second CR.5
NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
CR is associated with improved outcomes in adult patients with R/R B-cell precursor ALL5
- Patients who achieved CR following salvage treatment had better RFS than those who attained a CR with incomplete count recovery
- Higher rate of MRD positivity has been reported in patients with a CR with incomplete count recovery vs those with a CR
ALL=acute lymphoblastic leukemia; allo-SCT=allogeneic stem cell transplant; CR=complete remission; MRD=minimal residual disease; OS=overall survival; RFS=relapse-free survival; R/R=relapsed or refractory; SOC=standard of care; TKI=tyrosine kinase inhibitor.
References: 1. Gökbuget N, Dombret H, Ribera JM, et al. International reference analysis of outcomes in adults with B-precursor Ph-negative relapsed/refractory acute lymphoblastic leukemia. Haematologica. 2016;101(12):1524-1533. 2. Kantarjian HM, Thomas D, Ravandi F, et al. Defining the course and prognosis of adults with acute lymphocytic leukemia in first salvage after induction failure or short first remission duration. Cancer. 2010;116(24):5568-5574. 3. Shah BD, Ghobadi A, Oluwole OO, et al. KTE-X19 for relapsed or refractory adult B-cell acute lymphoblastic leukaemia: phase 2 results of the single-arm, open-label, multicentre ZUMA-3 study. Lancet. 2021;398(10299):491-502. 4. Data on file. Kite Pharma, Inc; 2021. 5. Saygin C, Papadantonakis N, Cassaday RD, et al. Prognostic impact of incomplete hematologic count recovery and minimal residual disease on outcome in adult acute lymphoblastic leukemia at the time of second complete response. Leuk Lymphoma. 2018;59(2):363-371. 6. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Acute Lymphoblastic Leukemia V.2.2021. © National Comprehensive Cancer Network, Inc. 2021. All rights reserved. Accessed July 20, 2021. To view the most recent and complete version of the guideline, go online to NCCN.org. 7. Fulcher J, Leung E, Christou G, Bredeson C, Sabloff M. Selecting the optimal targeted therapy for relapsed B-acute lymphoblastic leukemia. Leuk Lymphoma. 2020;61(9):2271-2273.