Treatment of Acute Lymphoblastic Leukemia with Philadelphia Chromosome (BCR::ABL1 Fusion Gene)
Clinical Scenario
This protocol applies to patients diagnosed with acute lymphoblastic leukemia (ALL) in whom testing has identified the Philadelphia chromosome (BCR::ABL1 fusion gene) in the leukemia cells — a distinct biological subtype that shapes treatment selection.
Approximately 25% of adults with ALL carry this chromosomal alteration, classifying them as Ph-positive ALL (Ph+ ALL). Its presence is a critical finding that directly determines the treatment approach.
Treatment Approach — Overview
Ph+ ALL is typically treated with a tyrosine kinase inhibitor (TKI) combined with other medication. CNS-directed therapy is also incorporated during treatment. For patients who cannot tolerate intensive chemotherapy, alternative TKI-based regimens are available…
The full regimen — including agent selection, sequencing, and all clinical decision points — is in the complete protocol.
References
- About 25 percent of adults with ALL have a subtype called Philadelphia chromosome-positive ALL (also known as "Ph+ ALL" or "Ph-positive ALL").
- This chromosomal alteration creates a fusion gene called BCR::ABL1.
- Patients who have Ph+ ALL are typically treated with tyrosine kinase inhibitors (TKIs), combined with other medication, either chemotherapy or a steroid.
- TKIs typically used to treat Ph+ ALL include dasatinib (Sprycel®), imatinib (Gleevec®), or ponatinib (Iclusig®).
- Patients also receive CNS-directed therapy during treatment.
- For patients who cannot tolerate intensive chemotherapy, researchers are also studying TKI-based regimens with low-dose chemotherapy or chemotherapy-free treatments with blinatumomab and inotuzumab ozogamicin.
View source ↗