Dasatinib and blinatumomab for patients with Philadelphia chromosome positive acute lymphoblastic leukemia

This study aimed to investigate the combination of dasatinib (Sprycel) and blinatumomab (Blincyto) as a first-line therapy in patients with Philadelphia positive (Ph+) acute lymphoblastic leukemia (ALL). 

This study concluded that this treatment combination led to better response and survival in these patients.  

Ph+ ALL is a rare type of ALL that has a genetic abnormality called the BCR-ABL gene or the Philadelphia chromosome. It usually has a poorer prognosis compared to those Ph negative. However, the outcomes for patients with Ph+ALL have improved with the use of tyrosine kinase inhibitors (TKIs). TKIs are a type of targeted therapy. Molecular remission (MR) is the primary goal of treatment. MR is the absence of the BCR-ABL gene in the blood.

Dasatinib is a TKI used to treat Ph+ ALL. Blinatumomab is an immunotherapy used for relapsed or refractory ALL. It was unknown if the combination of dasatinib and blinatumomab was safe and effective as a first line treatment in patients with Ph+ ALL. 

This study involved 63 adult patients with newly diagnosed Ph+ ALL. Patients received dasatinib plus glucocorticoids, followed by blinatumomab. The average follow-up was 18 months.

Complete remission (no signs of cancer left) was seen in 98% of patients after an average of 18 months. At the end of dasatinib induction therapy, 29% of patients had a MR. After the second cycle of blinatumomab treatment, 60% of patients had a MR. This percentage further increased after each blinatumomab cycle, reaching 81% after the 4th cycle.  

After 18 months, the overall survival (OS) rate was 95% and 88% of patients were disease-free. Six patients experienced disease relapse. 

21 moderate to severe side effects were recorded. These included low white blood cell counts, infections, persistent fever, and fluid build-up around the lungs.

24 patients received stem cell transplants from donors.  

This study concluded that chemotherapy-free induction and consolidation first-line treatment with dasatinib and blinatumomab was associated with very good responses and survival in adults with Ph+ ALL.

This study had a small number of participants and did not have a control group to compare treatments. Further larger studies are needed.