Brandon Dyson, PharmD, BCOP, BCPS: For standard of care currently, how we manage both chronic phase CML [chronic myeloid lymphoma] and Philadelphia chromosome positive ALL [acute lymphoblastic leukemia], it really revolves around using a TKI or a tyrosine kinase inhibitor directed at the fusion gene BCR-ABL. Really, CML does not exist without that gene. It is caused by the Philadelphia chromosome, or T922.

Since 2001, with the release of Imatinib, our entire treatment paradigm has been centralized around inhibiting and targeting that gene. We have different stratifications on whether we use a first-generation or second-generation TKI, just depending on risk score for the patient. There are a few different measurements that we can use to look at whether a patient's high-risk or low-risk. The Sokal score is probably one of the more predominant ones, but there are a few different ones available. That [score] stratifies whether we give them Imatinib, which is a first-generation TKI, or one of the second-generation [TKIs].

For ALL, it's a very similar strategy. We still have a Philadelphia chromosome; we still have a BCR-ABL fusion gene that we want to target. The difference is that they're also in an acute leukemia, so we have to take care of that. So, instead of just giving a TKI, what we end up doing with ALL that has the Philadelphia chromosome is we give them the TKI plus induction chemotherapy. For ALL, a very common regimen would be something like hyper-CVAD [cyclophosphamide, vincristine sulfate, doxorubicin hydrochloride, and dexamethasone], but again, other options do exist, and you might see differences on that.

Neal Dave, PharmD: Our organization manages CP-CML and Philadelphia-positive ALL similarly to any disease state that we are looking at. If we follow the national guidelines, our own pathways and look at therapies that qualify under those guidelines. I think in this case, with CML, ALL, and all the TKIs in this space have similar outcomes, overall survival and progression-free survival. There are studies that show one is maybe better than the other, but the overall survival is pretty high for all of those drugs. But there are some nuances and how and why you would select one therapy over the other. There are a lot of patient factors, you know, compliance to therapy, adverse events, toxicities, drug interactions, that are taken into account specifically in this category, or in this disease state.

Transcript edited for clarity.