Leukemia

Chimeric antigen receptor (CAR) T-cells have saved lives in some patients with acute lymphoblastic leukemia (ALL) who had run out of other treatment options. This type of immunotherapy is making inroads in other hematologic malignancies as well, but it is still being studied in very sick patients.

A durable complete response was achieved in a high proportion of adults with refractory B-cell malignancies who received CD19+ chimeric antigen receptor (CAR) T-cells made up of a defined 1:1 ratio of CD8+ and CD4+ cells.

Treatment with CD19-targeted immunotherapy blinatumomab (Blincyto) as a single agent showed antileukemic activity in patients with minimal residual disease (MRD) Philadelphia chromosome (Ph)-positive B-cell precursor acute lymphoblastic leukemia (ALL) whose disease progressed after or was intolerant to a second-generation or later tyrosine kinase inhibitor (TKI). The results were presented at ASH 2015.

Ibrutinib (Imbruvica) significantly reduced the risk for disease progression or death compared with standard treatment with chlorambucil (Leukeran) in older (aged ≥65 years) treatment-naive patients with chronic lymphocytic leukemia (CLL). Ibrutinib achieved a 91% reduction in the risk for disease progression and an 84% reduction in the risk for death compared with chlorambucil.

Idelalisib (Zydelig) reduced the risk for disease progression and death when added to bendamustine (Treanda) plus rituximab (Rituxan) versus bendamustine plus rituximab alone in patients with relapsed or refractory chronic lymphocytic leukemia (CLL), according to the results of a randomized, double-blind, placebo-controlled, phase 3 late-breaking trial presented at ASH 2015.

Dose-optimized nilotinib (Tasigna) increased the rates of major molecular response in patients with newly diagnosed chronic myeloid leukemia (CML) in the chronic phase (CP) in the Evaluating Nilotinib Efficacy and Safety in Clinical Trials-Extending Molecular Responses (ENESTxtnd) study. According to the final results of this study presented at ASH 2015, the cumulative major molecular response rates were 70.8% by 12 months and 81.0% by 24 months in patients managed with the dose optimization strategy.

In patients with B-cell precursor acute lymphoblastic leukemia (BCP-ALL), the addition of rituximab (Rituxan) to chemotherapy significantly improved event-free survival in a large European study.

Disease progression is slower and overall survival (OS) is greater in patients with chronic myeloid leukemia (CML) who are being monitored for their response to tyrosine kinase inhibitor (TKI) therapy and show good adherence. However, few clinicians monitor response and adherence to oral TKI treatment in patients with CML.

An investigational first-in-class ­anticancer quinolone derivative, vosaroxin, extended median over­­all survival (OS) when used with cytarabine (Cytosar-U) in a phase 3 clinical trial of patients with relapsed or refrac­­tory acute myeloid leukemia (AML), although the difference was not significant.

San Francisco, CA—In patients with acute lymphoblastic leukemia (ALL), assessment of minimal residual disease (MRD) is increasingly used to evaluate response to treatment. An antibody that recruits the body’s T-cells to attack MRD in patients with ALL whose disease is in remission can prevent full relapse.