Would concurrent CRLF2/IgH rearrangement affect your treatment recommendations for an adult patient with Ph+ p190 high risk (Age>35, WBC >30) B-cell ALL that was started on induction therapy with ponatinib + blinatumomab?

Short answer: No.

Longer answer: We lack a clear understanding of how to change treatment for adults with CRLF2 fusions with Ph- ALL, and this is the situation where it is more clearly understood to have prognostic significance (Roberts et al., PMID 27870571). In my view, it would be very difficult to justify making treatment decisions based on the presence of this genetic lesion in Ph+ ALL.

Broader topic: The choice of ponatinib + blinatumomab for this patient strikes me as worthy of comment. While the results from this combination are quite impressive and have left many in the field arguing this should be the standard, the results have come from ONE single-arm study from ONE institution with a median follow-up of ONLY 17 months at the late...