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Shorter, Chemo-Free Strategies Match or Beat Standard Care in Adult Leukemias at ASH

Investigators report deeper remissions with less intensive strategies, prompting plans for biomarker-guided personalization.

Overview

  • In CLL, a 909-patient randomized trial found fixed-duration venetoclax-based combinations were non-inferior to continuous ibrutinib for progression-free survival at a median 34 months.
  • Complete responses and undetectable measurable residual disease were markedly higher with fixed-duration regimens, whereas no patients on continuous ibrutinib achieved undetectable MRD.
  • Overall adverse events were comparable in CLL, with more cardiovascular events on prolonged ibrutinib and higher severe infection risk associated with obinutuzumab, including shorter PFS in aggressive disease subsets.
  • In Ph+ ALL, a 236-patient phase III trial showed ponatinib plus blinatumomab improved event-free survival (87% vs 71%) and lowered deaths (3.5% vs 10%) compared with imatinib plus chemotherapy at about 23 months.
  • The chemo-free Ph+ ALL regimen yielded higher complete remission (94% vs 79%) and MRD-negativity, and 37% of control patients who crossed over achieved MRD-negative status, with most deaths occurring in older patients and infections a leading cause.