ASH 2026 guideline recommendations for AYA patients with R/R ALL

The American Society of Hematology (ASH) 2026 guidelines for the treatment of adolescent and young adult (AYA) patients with relapsed/refractory acute lymphoblastic leukemia (R/R ALL) were published in Blood Advances by O’Dwyer et al. Eight recommendations were formed by a multidisciplinary panel of hematologists, AYA psychosocial care specialists, pharmacists, methodologists, and patient representatives to guide decisions for the treatment of AYA patients with R/R ALL. 

Key data: The panel recommends the use of blinatumomab and/or inotuzumab ozogamicin over chemotherapy for the treatment of patients with R/R B-cell ALL (B-ALL). Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is suggested for allo-HSCT-naïve patients with R/R B-ALL who have demonstrated a second or greater remission with FDA-approved CD19 CAR T-cell therapy (tisagenlecleucel or brexucabtagene autoleucel); allo-HSCT is suggested over chemotherapy alone for patients with R/R B-cell ALL who achieved a second or greater remission. Prior to allo-HSCT, the panel suggests myeloablative conditioning regimens that include total body irradiation (TBI) rather than chemotherapy alone for AYA patients with R/R ALL. For patients with isolated central nervous system (CNS) relapse of ALL, systemic CNS-directed therapy is recommended, while the panel recommends against CNS radiation alone. Nelarabine-based regimens are suggested for AYA patients with R/R T-cell ALL (T-ALL).

Key learnings: Establishing and adopting standardized, evidence-based guidance for the treatment of AYA patients with R/R ALL is crucial for improving outcomes and making informed decisions regarding their treatment.