Optimizing Transplant Timing in Acute Lymphoblastic Leukemia

Partow Kebriaei, MD, Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, MD Anderson Cancer Center, discusses when the optimal time for transplant is in patients with acute lymphoblastic leukemia (ALL).

In recent years, advances in treatment have transformed options for patients with ALL, leading to deeper remissions and raising new questions around the optimal timing for bone marrow and stem cell transplants. Here, Kebriaei, provides insight into when transplant is most beneficial, emphasizing the importance of minimal residual disease (MRD) status and the effectiveness of chimeric antigen receptor (CAR) T-cell therapy in guiding these decisions.

For newly diagnosed patients with ALL, MRD status plays a pivotal role in determining the timing of transplant. Kebriaei notes that when MRD levels indicate minimal or no residual disease, patients are prime candidates for a stem cell transplant, maximizing their chances of long-term remission.

For patients with advanced ALL, they historically would not have been transplant candidates due to challenges in achieving deep remission. However, Kebriaei points out that CAR T-cell therapy has dramatically changed the prognosis for these individuals. By driving these advanced patients into deep molecular remission, CAR T-cell therapy can enable even patients with high-risk ALL to become eligible for stem cell transplantation.

Transcription:

0:09 | So I think for upfront patients, we are using MRD to guide when to go forward. I think for advanced patients, and this is something that I touched on in my talk, we now can talk about the upfront patient, but what about that advanced patient, where in the past, we really did not even think about transplant because we could not get them into a deep enough remission? But now, we are able to get these patients, let us say, after CAR [T-cell] therapy, into a very deep molecular remission.

0:39 | So, should we then move very quickly with transplant as consolidation? I would posit that with the current data that we have, those patients, as soon as they achieve MRD negativity following CAR T therapy, as long as they are fairly fit, should then be considered for transplant. consolidation.