Backbone chemotherapy is not well defined when a tyrosine kinase inhibitor is involved in the treatment of Philadelphia chromosome (Ph)-positive acute lymphoblastic leukemia, says Dan Douer, MD. Younger children are often treated with pediatric protocols, but individuals 21 years and older tend to receive hyper-CVAD (cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate, and cytarabine).

Raoul Tibes, MD, comments that clinicians should treat young adults with a pediatric-inspired regimen. He encourages community hematologists who have limited experiences with these regimens to consult with their closest cancer center or refer patients when necessary. Jeffrey Lancet, MD, echoes Tibes’ comment stating that although pediatric regimens have demonstrated effectiveness in randomized controlled trials, they are complex and require a lot of experience and patient compliance, which may be challenging to achieve outside of a clinical trial.

Tibes mentions that clinicians approach all Ph-negative disease the same way, but recent data show there may be subsets of patients that fare poorly with current treatment. He states that clinicians and researchers should investigate the role of molecular profiling in this setting. Subtyping can aid in creating a standard of care for certain groups of patients, Douer suggests.