TKIs in Philadelphia Chromosome-Positive ALL

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The introduction of tyrosine kinase inhibitors (TKIs), like imatinib, for Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia (ALL) has revolutionized outcomes in younger patients and created an opportunity for more definitive therapy in older individuals, according to Jeffrey Lancet, MD. Lancet notes that several smaller series of studies have demonstrated high response rates and significant disease-free survival rates in individuals who received TKIs with modified chemotherapeutic regimens or steroids.

Dan Douer, MD, and Mark R. Litzow, MD, agree that adults with Ph+ ALL should undergo allogeneic stem cell transplant following treatment with TKIs. In many instances, the level of response induced by targeted therapies lends itself to better outcomes from transplant. However, whether imatinib should be administered following transplantation remains an area of debate.