Leila Macy achieves molecular remission from Ph-positive ALL

Symptoms and Diagnosis of Ph-Positive B-ALL

Born in Progreso Yoro, Honduras, the 57-year-old Miami resident lived with normal general health before her illness disrupted her daily life. For approximately two months, she experienced severe discomfort in her legs, frequent vomiting, and an inability to tolerate the smell of food. Medical testing ultimately identified her condition as Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia, a fast-growing cancer of the blood and bone marrow. In this specific subtype, leukemia cells carry an abnormal BCR::ABL1 gene that produces a protein driving the rapid growth of cancer cells. Firas El Chaer, M.D., hematologist-oncologist and chief of Leukemia and medical director of Infusion Services at Baptist Health Herbert Wertheim Cancer Institute, notes that this form of leukemia has historically been regarded as a higher-risk subtype because of its potential to relapse.

Targeted Therapies and Immunotherapy Approach

Ms. Macy began her treatment under Dr. El Chaer, whom she described as very kind. Her care regimen relied on a combination of oral targeted medications and intravenous immunotherapy rather than conventional, highly intensive chemotherapy alone. She received several targeted drugs designed to interfere with the specific protein driving her cancer, including imatinib, dasatinib, and later switching to ponatinib due to gastrointestinal complications. She also received blinatumomab, a continuous intravenous immunotherapy that helps the patient's immune system identify and attack cancer cells. Dr. El Chaer explains that combining these therapeutic approaches targets the disease through complementary mechanisms for selected patients.

Managing Treatment Complications

The treatment process required careful medical management to address side effects and complications. During her initial blinatumomab infusion, Ms. Macy developed chills, facial flushing, heart palpitations, and pain in both legs. Her care team temporarily stopped the infusion, administered medication to manage the reaction, and safely resumed treatment once her symptoms resolved. Subsequent gastrointestinal complications prompted her physicians to discontinue dasatinib and transition her care to ponatinib.

Achieving Complete Molecular Remission

Physicians track treatment effectiveness through blood tests, bone marrow examinations, and molecular assays to detect whether any cancer cells remain. Bone marrow biopsy results showed normal blood cell production without an excess of immature leukemia cells, known as blasts. Specialized testing also confirmed no measurable residual disease, indicating that tiny numbers of cancer cells were no longer detectable. The BCR::ABL1 molecular marker associated with her cancer became undetectable. Dr. El Chaer states that Ms. Macy achieved complete molecular and measurable residual disease-negative remission, which is a highly favorable response. Subsequent follow-up testing has continued to show no detectable residual leukemia, allowing her to resume her career and daily routine.