A 22-year-old woman presents with BCR-ABL1-positive acute lymphoblastic leukaemia (Ph+ ALL). Apart from induction chemotherapy, which targeted therapy is incorporated into first-line treatment to significantly improve outcomes?
- A Rituximab added to induction for its anti-CD20 activity in ALL
- B Blinatumomab as a bridge to allogeneic stem cell transplant
- C Venetoclax targeting BCL-2 overexpression in Ph+ ALL
- D Dasatinib (or imatinib) added to standard induction chemotherapy ✓
Explanation
Ph+ ALL (BCR-ABL1 positive) constitutes ~25% of adult ALL and historically carried a poor prognosis. The addition of a BCR-ABL1 tyrosine kinase inhibitor — imatinib (first-generation) or dasatinib (second-generation, preferred for CNS penetration) — to induction chemotherapy dramatically improves complete remission rates and molecular response. Dasatinib is now preferred due to superior CNS penetration and better inhibition of T315I mutations. Subsequent allogeneic SCT is performed in eligible patients. Blinatumomab (anti-CD19/CD3 bispecific T-cell engager) is used for relapsed/refractory B-ALL. Rituximab is added in CD20+ B-ALL subtypes.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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