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More Research Required to Advance Pediatric Ph-Like ALL Paradigm

Caroline Seymour
Published: Monday, Oct 22, 2018

Sarah K. Tasian, MD

Sarah K. Tasian, MD
Though there is no frontline standard for patients with pediatric Philadelphia (Ph)-like acute lymphoblastic leukemia (ALL), Sarah K. Tasian, MD, explained that timely diagnostic interventions and subsequent enrollment on clinical trials will drive the treatment paradigm forward.

, Tasian, an attending physician and assistant professor of pediatrics in the Division of Oncology at Children’s Hospital of Philadelphia, discussed the diagnostic and therapeutic approaches to treating patients with pediatric Ph-like ALL.

OncLive: Is there a difference between Ph-like ALL and Ph-positive ALL?

Tasian: Yes. The 2 types of leukemia have a similar kinase activated gene expression profile, but they have totally different underlying genetic lesions.

At the 2018 SOHO Annual Meeting, you presented on the diagnostic and therapeutic approach to taking care of patients with Ph-like ALL. Could you give an overview of that?

I reviewed the biology of the leukemias, the different genetic alterations that comprise those biologies, and how we diagnose patients using current clinical and previously researched testing algorithms. I covered practical tips about what you can do with routine clinical testing to identify some of these patients. Additionally, I gave a review of the preclinical data that informed some current clinical trials that are testing tyrosine kinase inhibitors (TKIs) and specific genetic subsets of patients with Ph-like ALL.

How are patients screened for this disease?

We do things a little bit differently in pediatric patients than in adults. We have a pretty complicated, tiered genetic testing algorithm for children. We test all of our patients with high-risk B-cell ALL who were treated on our frontline Children's Oncology Group phase III clinical trial. We test all of our newly diagnosed patients with high-risk B-cell ALL, first by a gene expression screening tool called a low-density microarray (LDA). That helps us identify patients who don't need the testing because they don't have Ph-like ALL. For patients who have Ph-like ALL, it helps us tier the downstream molecular testing based on what we see on that LDA.
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