A 55-year-old woman is diagnosed with Philadelphia chromosome-positive ALL (Ph+ ALL). She receives standard induction chemotherapy. Which addition to the induction regimen has significantly improved outcomes and is now standard of care?
- A Addition of bortezomib to HYPER-CVAD
- B Addition of rituximab only
- C Addition of a BCR-ABL tyrosine kinase inhibitor (imatinib, dasatinib, or ponatinib) ✓
- D Allogeneic SCT in first CR without any TKI
Correct answer: C. Addition of a BCR-ABL tyrosine kinase inhibitor (imatinib, dasatinib, or ponatinib)
Explanation
Ph+ ALL is the most common cytogenetic abnormality in adult ALL (25–30%) and historically carried a poor prognosis. The addition of BCR-ABL TKIs (imatinib, dasatinib, or ponatinib for T315I mutations) to chemotherapy induction has dramatically improved complete remission rates and overall survival. Current guidelines (NCCN) recommend TKI-based regimens as standard of care; ponatinib is preferred in patients with T315I mutation. This is categorically different from rituximab which targets CD20-positive B-cell ALL.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.