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Summary: To reducing chemotherapy‐related toxicity, the chemo‐free regimens become a new trend of Ph + ALL treatment. Therefore, we conducted a phase 2 trial of dasatinib plus prednisone, as induction (Course I) and early consolidation (Courses II and III) treating newly diagnosed Ph + ALL. The trial was registered at www.chictr.org.cn, ChiCTR2000038053. Forty‐one patients were enrolled from 15 hospitals. The complete remission (CR) was 95% (39/41), including two elderly induction deaths. By the end of Course III, 25.6% (10/39) of patients achieved a complete molecular response. With a median follow‐up of 15.4 months, 2‐year disease‐free survival (DFS) were 100% and 33% for patients who receiving haematopoietic stem cell transplantation (HSCT) at CR1 and receiving chemotherapy alone respectively. When censored at time of HSCT, 2‐year DFS were 51% and 45% for young and elderly patients (p = 0.987). 2‐year overall survival were 45%, 86% and 100% for patients without HSCT, receiving HSCT after relapse and receiving HSCT at CR1 respectively. A total of 12 patients had marrow recurrences and one had CNS relapse, with 38% occurred early (between Courses I and III). IKZF1 gene deletion was shown to be associated with relapse (p = 0.019). This chemo‐free induction and early consolidation regimen was efficacious and well‐tolerated in de novo Ph + ALL. Allogeneic HSCT conferred definite survival advantage after chemo‐free induction. [ABSTRACT FROM AUTHOR]

It was designed to effectively target wild-type BCR-ABL1 and a wide range of BCR-ABL1 mutants, including T315I, making it a promising reinduction therapy for relapsed Ph + B-ALL. E255K, T315I, and a compound of T315I and Q252H mutations were identified in 3 BCR-ABL1 P210-positive patients, respectively, whereas no mutations were found in 2 BCR-ABL1 P190-positive patients. Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph + B-ALL) was one of high risky B-cell ALL subtypes that exhibits resistance to conventional chemotherapy [[1]]. Moreover, the induction therapy for Ph + B-ALL evolved from TKI plus intensive chemotherapy to TKI plus corticosteroids, which also supported that TKI was the backbone for Ph + B-ALL treatments. [Extracted from the article]

Unfortunately, only one patient sample was available, and more patient samples need to be verified in the future. All patients had the T315I mutation alone or compound mutation when relapsed before VPD regimen treatment, including 15 patients with the T315I mutation alone and 4 with compound kinase mutations (100% T315I + 50% E255K/V, 100% T315I + 100% E279K, 100% T315I + 100% Y253H, and 54% G250E + 36% F359V for each). For post-remission treatment, 6 patients who attained CMR directly received allo-HSCT, and the remaining 11 patients continued to receive the VPD regimen. Of the 6 patients who received allo-HSCT, 2/6 (patient 1 and patient 19) received 45 mg of ponatinib per day as maintenance treatment, and 4 other patients did not receive maintenance treatment. [Extracted from the article]

Summary: Minimal residual disease (MRD) is an important independent prognostic factor for relapse and survival in acute lymphoblastic leukaemia (ALL). Compared with adult B‐cell ALL, reports of adult T‐cell ALL (T‐ALL) MRD have been scarce and mostly based on molecular methods. We evaluated the prognostic value of multiparameter flow cytometry (FCM)‐based MRD at the end of induction (EOI‐MRD). The present retrospective study included 94 adult patients with T‐ALL. MRD was detected by six‐ to eight‐colour FCM. Patients who were EOI‐MRD positive had a higher cumulative incidence of relapse (CIR) (87·6% vs. 38·8%, P = 0·0020), and a lower relapse‐free survival (RFS) (5·4% vs. 61·0%, P = 0·0005) and overall survival (OS) (32·7% vs. 69·7%, P < 0·0001) than those who were EOI‐MRD negative. Moreover, for patients who received allogeneic haematopoietic stem cell transplantation (allo‐HSCT) at their first remission, EOI‐MRD positivity was predictive of post‐transplant relapse (2‐year CIR: 68·2% vs. 4·0%, P = 0·0003). Multivariate analysis showed that EOI‐MRD was an independent prognostic factor for CIR [hazard ratio (HR) 2·139, P = 0·046], RFS (HR 2·125, P = 0·048) and OS (HR 2·987, P = 0·017). In conclusion, EOI‐MRD based on FCM was an independent prognostic factor for relapse and survival in adult T‐ALL. For patients who underwent HSCT, EOI‐MRD could be used to identify patients with a high risk of relapse after allo‐HSCT. [ABSTRACT FROM AUTHOR]