OnCo
ideasIdea

Transplant-free Ph-positive ALL for MRD-negative adults

If a pill plus immunotherapy makes the leukaemia undetectable, can most adults safely skip a bone-marrow transplant?

Half of D-ALBA patients were not transplanted and did well; MD Anderson ponatinib-blinatumomab cohorts report ~85% 3-year OS with few transplants. Randomised confirmation is needed, especially for IKZF1-plus genotypes.

Hypothesis
Adults with Ph+ ALL who achieve complete molecular remission after TKI + blinatumomab have equivalent OS with TKI maintenance and MRD surveillance versus allogeneic transplant in CR1.
Rationale
Transplant mortality (10-20%) may exceed the relapse risk it prevents in molecularly negative patients; blinatumomab and ponatinib rescue many relapses.
What would test it
A trial would randomise MRD-negative patients after induction/consolidation to transplant vs TKI maintenance with monthly BCR::ABL1 PCR and pre-emptive blinatumomab; primary endpoint OS at 3 years.
Maturity
being tested at scale

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