Blinatumomab + ponatinib for relapsed/refractory Philadelphia chromosome-positive acute lymphoblastic leukemia in adults

Abstract

We retrospectively examined the results of a new chemo-free approach combining blinatumomab with ponatinib (blina/pona) in 26 relapsed/refractory Philadelphia positive (Ph+) acute lymphoblastic leukemia (ALL) patients. All but one achieved complete morphologic remission, and 23 achieved a complete molecular response. With a median follow-up of 34.4 months, the median overall (OS) and event-free (EFS) survivals were 20 and 15.3 months, respectively. After blina/pona, 8 patients underwent an allotransplant (allo), while among the 18 non-transplanted cases, 15 received ponatinib in maintenance. Fifteen relapse/progressions occurred with a significant difference between allo and non allo cases (12.5% vs 82.3%, p = 0.003). However, OS and EFS were similar between both groups. Finally, blina/pona was well tolerated with eight reversible neurologic events and three cytokine release syndromes. Prospective studies are needed to properly assess the safety, tolerability and efficacy of the combination therapy.

Keywords:

• Relapsed/refractory Philadelphia chromosome-positive
• acute lymphoblastic leukemia
• blinatumomab
• ponatinib

Acknowledgments

The authors thank all the nurses for their dedicated patient care.

Disclosure statement

PC had received honoria from Incyte and AMGEN companies. The other authors declare no conflict of interest.

Author contributions

MAC and PC designed, performed, coordinated the research, analyzed, interpreted the data, and wrote the manuscript.

XT, ER, FH, CB, CS, MPGH, YH, MHB, CS, TL and MCB contributed data and commented on the manuscript. MCB helped to write the manuscript.