A 35-year-old woman is diagnosed with Philadelphia-positive ALL. After induction with hyper-CVAD plus imatinib achieving complete remission, what is the preferred consolidation strategy?

• A Autologous stem cell transplantation
• B Maintenance imatinib alone for 2 years
• C Ponatinib monotherapy
• D Allogeneic haematopoietic stem cell transplantation in first CR ✓

Explanation

Philadelphia-positive ALL (BCR-ABL1+) carries high risk of relapse and allo-HSCT in first complete remission remains the standard of care for eligible patients under 55–60 years, as it provides the best chance of long-term cure. Dasatinib or ponatinib-based induction followed by allo-HSCT is now standard per current ALL guidelines. Autologous HSCT is inferior. Maintenance TKI alone has high relapse rates. Ponatinib monotherapy is reserved for T315I-mutant relapsed disease.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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