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BCR::ABL1 TKI + blinatumomab (chemotherapy-free Ph+ ALL)
A pill that switches off the leukaemia's engine plus an immunotherapy that mops up survivors, with no chemotherapy.
D-ALBA (dasatinib) and MD Anderson (ponatinib) series achieve molecular remission in most adults with far less toxicity than hyper-CVAD; randomised trials against chemotherapy-containing regimens are underway (GIMEMA ALL2820).
Rationale
TKI collapses the Ph+ clone quickly; blinatumomab clears MRD-level disease that harbours TKI-resistant subclones, and its CD19 mechanism is independent of kinase mutations.
Evidence
Phase 2 (D-ALBA, MDACC); phase 3 pending.