Highlights from the SWG
The major focus of the EWALL study groups is described in the following.
Stem Cell Transplantation:
The indications of stem cell transplantation but also the procedures including dose-reduced conditioning are a topic of ongoing debate in the EWALL group. The group worked on a joint EWALL-EBMT recommendation for stem cell transplantation in ALL.
Studies for older patients with ALL:
Treatment of older ALL patients is an absolute medical need and major focus of the SWG. The ALL study groups focussed on several aspects in the treatment of older patients with ALL. Several new protocols with a combination of immunotherapy and dose reduced chemotherapy were prepared and to be activated in 2018.
Treatment of Ph-positive ALL:
The prognosis of Ph/BCR-ABL positive ALL has been improved by the use of tyrosine kinase inhibitors (TKI); however, challenges are still present. This includes the indication for SCT, the definition of standards for younger and older patients, the use of 2nd and 3rd generation TKIs, the role of MRD and method standardisation, MRD based treatment decisions and the handling of toxicities.
For a first joint EWALL study, a publication was finalized (Rousselot et al. Dasatinib and low-intensity chemotherapy in elderly patients with Philadelphia chromosome-positive ALL. Blood. 2016 Aug 11;128(6):774-82). For a second trial with Nilotinib in combination with the EWALL backbone, the data set was completed for publication in 2018. A third trial with 3rd generation TKI and potentially immunotherapy was discussed and is in the planning phase. After joint lab rounds, a publication on standards for MRD detection in Ph-positive ALL was prepared.
- Blinatumomab (anti-CD3/CD19) in MRD positive ALL
A study in MRD-positive patients, to achieve MRD-negativity with Blinatumomab was highly successful (80% response rate). This study was only possible in the infrastructural setting of the European ALL study groups. A final publication was accepted in 2017.
- Blinatumomab in de novo ALL
Several groups planned and discussed first-line trials with Blinatumomab in younger patients to be started in 2018.
Historical comparator studies:
Two large historical comparator trials were completed by the EWALL.
- Retrospective analysis of outcome of relapsed/refractory ALL with European, but also US study groups.
- Weighted analysis for the comparison of historical data with data gained by phase II study with Blinatumomab.
Two further comparator trials for MRD positive ALL were completed in 2017 and will be submitted for publication in 2018.
Several group members are part of the Harmony project as key opinion leaders and facilitated the discussion on the first ALL pilot projects within the harmony network.
Several SWG members were involved in educational activities during international hematology conferences and published review articles.