From the Guidelines
The treatment for blast crisis in Acute Lymphoblastic Leukemia (ALL) should prioritize intensive chemotherapy regimens, with the addition of targeted therapies such as tyrosine kinase inhibitors (TKIs) for Philadelphia chromosome-positive cases, as recommended by the most recent guidelines 1. The approach to treating blast crisis in ALL involves induction chemotherapy, which may include a combination of agents such as vincristine, daunorubicin, pegylated asparaginase, and prednisone.
- Key considerations include:
- The use of rituximab in adult Burkitt lymphoma/leukaemia and CD20+ BCP-ALL, as strongly recommended by recent guidelines 1.
- The potential benefit of ofatumumab in addition to hyper-CVAD for patients with CD20+ Ph ALL, particularly those with low CD20 expression in blast cells 1.
- The importance of consolidation therapy with blinatumomab for patients with Ph ALL and MRD persistence after induction and consolidation, as it improves MRD response and outcome 1. For Philadelphia chromosome-positive cases, the addition of a TKI such as ponatinib is considered, as it may improve patient outcomes compared to first- or second-generation TKIs 1.
- Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a crucial component of treatment for eligible patients, offering the best chance for long-term survival. The treatment of blast crisis in ALL requires careful monitoring for complications, including tumor lysis syndrome, infections, and organ toxicity, and should be initiated promptly to improve outcomes.
From the FDA Drug Label
1.2 Ph+ CML in Blast Crisis (BC), Accelerated Phase (AP) or Chronic Phase (CP) After Interferon-alpha (IFN) Therapy 1.3 Adult Patients With Ph+ Acute Lymphoblastic Leukemia (ALL) 1.4 Pediatric Patients With Ph+ Acute Lymphoblastic Leukemia (ALL) 2.4 Adult Patients With Ph+ ALL 2.5 Pediatric Patients With Ph+ ALL
The treatment for Acute Lymphoblastic Leukemia (ALL) in blast crisis is not directly addressed in the provided drug label for imatinib. However, the label does indicate that imatinib is used to treat Ph+ ALL in adult and pediatric patients 2.
- Key points:
- Imatinib is used for Ph+ ALL.
- The label does not provide specific information on the treatment of ALL in blast crisis. It is essential to consult the full prescribing information and other relevant resources for guidance on treating ALL in blast crisis.
From the Research
Treatment Options for Blast Crisis in ALL
- The treatment of Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) has improved with the use of tyrosine kinase inhibitors (TKIs) in combination with chemotherapy 3, 4, 5, 6.
- Studies have shown that the combination of hyper-CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) and dasatinib is effective in achieving long-term remission for patients with newly diagnosed Ph+ ALL 3, 4.
- The use of ponatinib, a third-generation TKI, has been shown to be superior to other TKIs in inducing and maintaining a complete molecular response (CMR) in patients with Ph+ ALL 5, 6.
- Allogeneic stem cell transplantation (ASCT) may not be necessary for patients who achieve early and deep molecular responses with TKI-based therapies 5, 6.
Chemotherapy Regimens
- The hyper-CVAD regimen has been shown to be effective in achieving complete remission and overall survival in patients with ALL 7.
- Modified hyper-CVAD regimens have also been shown to be effective and have an acceptable 5-year overall survival rate comparable to standard hyper-CVAD regimens 7.