The study is about the attempt to reduce toxicity. Because in children in particular toxicity is a big issue, particularly if you need a lot of chemotherapy or even transplant. Therefore we initiated a study in which we wanted to replace some part of the chemotherapy through immunotherapy using a bispecific antibody which is called blinatumomab.
What was the study design?
The study design is a phase III study, it’s an investigator-initiated study. It’s an international study in eight countries with roughly one thousand patients a year. In the high-risk group we have roughly 20% of those.
What were the key results?
The results are really quite surprising to us because we expected less toxicity and this is true, it’s actually better than we had expected – the toxicity really dropped down. Also for patients who had an indication for transplant, their mortality really went down sharply. But in addition we were surprised to see that there’s a really strong reduction in relapses, nearly by 50%.
What could be the clinical significance of these results?
This is highly significant because it really changes the thinking about high-risk leukaemia. Is it still high-risk if it has an event free survival of 83%? So we have to think about the definition of leukemic subgroups, prognostic subgroups. Of course it opens the door to de-intensify the treatment intensity for children with leukaemia and if there’s a perspective in replacing chemotherapy elements by immunotherapy this will be fantastic, in particular with regard to acute and late toxicity in children.
What’s next for the study?
The next is, of course, very logically to apply the same principle to other risk groups in ALL. Because right now we focused on the 20% high-risk patients but we need to focus also on the 80% other patients. I see the perspective that we will introduce immunotherapy very soon, actually in September we are starting the first study for that. It’s again a phase III study in which we randomise basically out-patient-based leukemic treatment, anti-leukemic treatment, versus standard chemotherapy.
I think we are really at a turning point here in the history of ALL treatment. ALL treatment is a success story in paediatric oncology but now we’re at a point where we turn the page and really get into a new era. I’m convinced.
