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Treatments for ALL: Chemo and Beyond

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Published on March 5, 2020

Key Takeaways

  • Most ALL treatments still rely on aggressive, multi-agent chemotherapy. Afterwards, a stem cell transplant can be used to help patients stay in remission.
  • Patients who have the Philadelphia chromosome may have success with oral therapy and steroids.
  • Blinatumomab (Blincyto) is an FDA-approved drug that is given through a continuous infusion.

Dr. Ryan Cassaday, acute lymphoblastic leukemia researcher at the Fred Hutchinson Cancer Research Center, walks through different strategies for treating ALL; including chemotherapy, stem cell transplant and monoclonal antibodies given as a continuous infusion. Watch as Dr. Cassaday discusses ALL treatment goals, identifying patient subsets and research on targeted therapies.  

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Transcript | Treatments for ALL: Chemo and Beyond

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:         

The treatments traditionally, certainly in children, but also in adults, have been pretty heavy duty. Chemo. Stem cell transplant. It’s tough. And I know in children it can be a curative. So, where are we now with—I don’t know if I should say kinder, gentler treatments, but treatments that maybe are done in new ways?

Dr. Cassaday:             

So, the backbone for most treatment of adults and young adults with ALL still relies on aggressive multi-agent chemotherapy. With the advent of some of the newer modalities and newer agents and newer understanding that we have, there’s certainly a lot of interest in our field to try to be a little bit more refined, to be a little bit more targeted with some of the interventions we have. The unfortunate reality is a lot of that is still investigational. It hasn’t necessarily borne out in good enough studies to know for sure that we can do that.

One notable exception though is again the subset of ALL where the Philadelphia chromosome was present. This is a subset where we have pills that can block the signal that this abnormal gene turns on. And there have been a number of studies to show that response rates can be very high with—instead of getting multi-drug chemotherapy over weeks and weeks, this pill, maybe with a little bit of a steroid medicine like prednisone, can actually get people into remission. Very, very reliable. So, we’re definitely trying to get there. In some cases, we’re getting closer, but in other cases we’ve still got a lot of work to do.

Andrew Schorr:         

And the role of transplant now? 

Dr. Cassaday:             

So, generally speaking stem cell transplant or bone marrow transplant, using the term sort of synonymously for the sake of this discussion, it’s a tool that we use to try to improve the chances that a patient is going to stay in remission. So, the initial therapy, the goal of that is to typically get people into remission. And what I typically tell patients is, "Cure is remission forever." So, if we can keep people in remission, that is what gets us to cure.

Now chemotherapy, as you alluded to before, can cure adults and children with ALL, just not as regularly as in adults. So, in some circumstances we’ll consider the use of stem cell transplantation when a patient’s in remission to try to increase the chances that the patient will stay in remission and that this will be the one and only time they have to deal with the disease. 

Andrew Schorr:         

One other group of therapies has been these monoclonal antibodies. And I understand some are delivered with what they call continuous infusion. So, how does that work? 

Dr. Cassaday:             

Yeah. So, there is an FDA-approved medication called blinatumomab (Blincyto). A bit of a mouthful, but it’s actually a—it’s engineered to be two pieces of two different antibodies that helps your immune system find a cell that has a target of interest, specifically CD19. It has to be given as a continuous infusion, because this protein is relatively small, and it ends up getting cleared out by your kidneys very quickly. So, in order to keep it in your body at a meaningful level, the drug has to be delivered as a very slow continuous drip intravenously. And a treatment interval is four weeks with a two-week break in between.

So, while this is a really interesting and really in some cases very effective therapy in patients where chemo has already failed in some way, it is a bit logistically cumbersome, to put it mildly.

Andrew Schorr:         

So, you might have a little fanny pack or something like...?

Dr. Cassaday:             

Yeah. That’s exactly what I tell patients when I’m talking about this, that if the patient or their significant other has a purse or a backpack of some sort, I’ll often point to that accessory and say, “Well, you know it’s about the size of that,” that they have to carry around. And it’s unlike just when you’re going to the store or going to work, you literally have to carry this thing around 24 hours a day for 28 straight days. 

Andrew Schorr:         

Okay. Well, I think you’re all—all of you in research are looking for ways that can improve towards cure, and can you have a delivery system that works, and people can go on with their life.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.  

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