Treatment-free remission in non-transplanted adult patients with Ph+ ALL in CR1

Results from a single-center, retrospective cohort study (N = 17) examining tyrosine kinase inhibitor (TKI) discontinuation in adults with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) in first complete molecular remission (CMR) without allogeneic hematopoietic stem cell transplantation (allo-HSCT) were presented by Eitan Kugler at the European Hematology Association (EHA) 2026 Congress, June 11–14, 2026, Stockholm, SE.

Key data: Median time on TKI was 65.2 months (range, 31.3–124.8 months), and median CMR duration before TKI discontinuation was 52.2 months (range, 2.7–121.4 months). Median follow-up after TKI discontinuation was 47.9 months. Treatment-free remission (TFR) was maintained in 76% (13/17) of patients at a median follow-up of 47.9 months. TFR rates were 82.4% at 12 months and sustained CMR >48 months before discontinuation was associated with 100% TFR. Relapse occurred in four patients (24%; p190, n = 3; p210, n = 1); three of four regained molecular response after restarting TKI therapy, while the 4th patient had not yet restarted therapy at the time of reporting.

Key learning: TKI discontinuation may be feasible in carefully selected patients with Ph+ ALL who have achieved a sustained CMR for >48 months prior to discontinuation, with sustained TFR achieved without relapse in this subgroup. Larger studies incorporating polymerase chain reaction (PCR) and next-generation sequencing (NGS) measurable residual disease (MRD) monitoring are needed to validate these findings.