Department of Internal Medicine, New York Medical College, St. Mary's and St. Clare's Hospitals, Denville, NJ.
Department of Internal Medicine, New York Medical College, Saint Michael's Medical Center, Newark, NJ.
Clin Lymphoma Myeloma Leuk. 2024 Oct;24(10):e376-e384. doi: 10.1016/j.clml.2024.06.002. Epub 2024 Jun 12.
The historical standard of care for Ph+ ALL is chemotherapy plus a tyrosine kinase inhibitor (TKI). Recently chemotherapy-free regimens have shown promising efficacy. We performed a meta-analysis to compare the efficacy of chemotherapy-free regimens for Ph+ ALL.
We searched PubMed and Embase for chemotherapy-free regimens for Ph+ ALL published between January 2000 and October 2023. Of the 5,348 articles screened, 9 nonrandomized clinical trials enrolling 413 patients were included. Two trials (N = 117) included treatment with 3 agents (blinatumomab, TKI, and steroid) and 7 trials (N = 248) included treatment with 2 agents (TKI and steroids). R software was used to conduct the meta-analysis (PROSPERO registration no. CRD42023482439).
The pooled complete molecular response (CMR) rate of patients receiving a TKI, blinatumomab, and steroids was 81% (95%CI, 69%-89%). TKIs plus blinatumomab were nearly 6 times as likely to have CMR (odds ratio [OR], 5.98; 95%CI, 2.99-11.96) and more than 5 times as likely to be alive at 1-year (OR, 5.1; 95%CI, 1.74-14.9) as compared to TKIs alone. Patients receiving ponatinib were about twice as likely as those receiving dasatinib to achieve CMR (OR, 2.51; 95%CI, 0.72-8.72).
Adding blinatumomab to TKIs and steroids significantly improved Ph+ ALL patients' response and survival rates. Regimens with ponatinib elicited higher molecular response rates than those with other TKIs. The high response and survival rates achieved with blinatumomab plus TKIs and steroids suggest that further studies are required to assess the need for intensive treatments such as chemotherapy or stem cell transplant in these patients.
Ph+ ALL 的历史标准治疗方法是化疗加酪氨酸激酶抑制剂（TKI）。最近，无化疗方案显示出有前景的疗效。我们进行了一项荟萃分析，以比较 Ph+ ALL 的无化疗方案的疗效。
我们在 PubMed 和 Embase 上搜索了 2000 年 1 月至 2023 年 10 月期间发表的 Ph+ ALL 无化疗方案的文章。在筛选出的 5348 篇文章中，纳入了 9 项非随机临床试验，共纳入 413 名患者。其中两项试验（N=117）包含 3 种药物（blinatumomab、TKI 和类固醇）治疗，7 项试验（N=248）包含 2 种药物（TKI 和类固醇）治疗。使用 R 软件进行荟萃分析（PROSPERO 注册号 CRD42023482439）。
接受 TKI、blinatumomab 和类固醇治疗的患者的完全分子缓解（CMR）率为 81%（95%CI，69%-89%）。TKI 加 blinatumomab 的 CMR 发生率几乎是 TKI 单药治疗的 6 倍（比值比[OR]，5.98；95%CI，2.99-11.96），1 年生存率是 TKI 单药治疗的 5 倍以上（OR，5.1；95%CI，1.74-14.9）。与接受 dasatinib 的患者相比，接受 ponatinib 的患者达到 CMR 的可能性约为两倍（OR，2.51；95%CI，0.72-8.72）。
在 TKI 和类固醇中添加 blinatumomab 可显著提高 Ph+ ALL 患者的缓解率和生存率。ponatinib 方案引起的分子反应率高于其他 TKI 方案。blinatumomab 加 TKI 和类固醇的高缓解率和生存率表明，需要进一步研究这些患者是否需要化疗或干细胞移植等强化治疗。
