The combination of BCR-ABL tyrosine kinase inhibitors (TKIs) and chemotherapy has significantly improved outcomes among patients with Philadelphia chromosome-positive (Ph +) acute lymphoblastic leukemia (ALL) [
1]. However, as mortality rates during induction for combined TKI and conventional chemotherapy range from ~ 7% [
2], and toxicity and treatment-related mortality rates need to be improved. Recently, reduced-intensity chemotherapy + TKI regimens [
3,
4] and chemotherapy-free regimens, such as TKI + steroid [
5,
6] or TKI + blinatumomab [
7,
8], have been developed. In the GIMEMA LAL1811 trial, including “unfit” patients with newly diagnosed Ph + ALL, 44 patients received 45 mg of ponatinib (PONA) daily with prednisone, and complete hematological remission (CHR) was achieved in 86.4% at 24 weeks. However, complete molecular response (CMR) was low at 40.9% at 24 weeks, and overall survival at two years remained at 62% [
6,
9]. The incidence of cardiovascular events (CVE) was ~ 30% due to the dose of PONA being set at 45 mg/day [
6]. Therefore, studies are required to optimize the dose of PONA and steroids. Here, we describe the results of a retrospective review of clinical records of six elderly or frail patients with Ph + ALL who underwent combination therapy with PONA and steroids at our institution between January 2018 and March 2021. This study was approved by the institutional ethics committee of the National Cancer Center Hospital East, Kashiwa, Japan. …
