All content on this site is intended for healthcare professionals only. By acknowledging this message and accessing the information on this website you are confirming that you are a Healthcare Professional. If you are a patient or carer, please visit Know ALL.

The ALL Hub uses cookies on this website. They help us give you the best online experience. By continuing to use our website without changing your cookie settings, you agree to our use of cookies in accordance with our updated Cookie Policy

Introducing

Now you can personalise
your ALL Hub experience!

Bookmark content to read later

Select your specific areas of interest

View content recommended for you

Find out more
  TRANSLATE

The ALL Hub website uses a third-party service provided by Google that dynamically translates web content. Translations are machine generated, so may not be an exact or complete translation, and the ALL Hub cannot guarantee the accuracy of translated content. The ALL Hub and its employees will not be liable for any direct, indirect, or consequential damages (even if foreseeable) resulting from use of the Google Translate feature. For further support with Google Translate, visit Google Translate Help.

Steering CommitteeAbout UsNewsletterContact
LOADING
You're logged in! Click here any time to manage your account or log out.
LOADING
You're logged in! Click here any time to manage your account or log out.

The ALL Hub is an independent medical education platform, sponsored by Jazz Pharmaceuticals, Amgen, and Pfizer. The funders are allowed no direct influence on our content. The levels of sponsorship listed are reflective of the amount of funding given. View funders.

2024-03-01T09:25:24.000Z

Debate: Should patients with Ph− ALL who reach MRD-negativity receive allo-HSCT?

Mar 1, 2024
Share:
Learning objective: After reading this article, learners will be able to cite a new clinical development in ALL.

Bookmark this article

Over the past 20 years, the prognosis of Philadelphia chromosome-negative (Ph−) B-cell or T-cell acute lymphoblastic leukemia (ALL) has significantly improved with the introduction of intensive chemotherapy protocols and targeted therapies such as immunotoxins, T-cell bispecific engagers, and chimeric antigen receptor T-cell therapies. The use of allogeneic hematopoietic stem cell transplantation is widely debated in patients with Ph− ALL, as these patients can now be effectively treated without this highly toxic procedure.

Here, we present a debate by Chevallier.1 and Boissel.2 published in The Lancet Hematology on whether patients with Ph− ALL who reach measurable residual disease (MRD) negativity should receive allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Key points

  • Allo-HSCT is indicated in patients at a high risk of relapse, defined as a high level of MRD or MRD positivity.
  • Allo-HSCT is indicated for adult patients in first line therapy and in pediatric patients in both first-line and second-line therapies1; however, the role of transplant in older patients and those with relapsed/refractory disease who are MRD-negative is largely debated.1 The authors opinion on this debate are presented in Figure 1.

Figure 1. Debate on whether allo-HSCT should be given to patients with Ph− ALL who reach MRD-negativity* 

ALL, acute lymphoblastic leukemia; allo-HSCT, allogeneic hematopoietic stem cell transplantation; MRC, Medical Research Council; MRD, measurable residual disease; OS, overall survival; PCR, polymerase chain reaction; R/R, relapsed/refractory; WBC, white blood count.
*Adapted from Chevallier.1 and Boissel.2

Key learnings
  • Allo-HSCT is a feasible option for younger adults with Ph− ALL who reach MRD-negativity, but it should not be the only criteria guiding transplant indication.
  • For older patients with Ph− ALL, the use of early blast clearance or other baseline high-risk features should be considered to indicate HSCT when MRD monitoring is not available.

  1. Chevallier P. Should patients with Ph-negative acute lymphoblastic leukaemia who reach minimal residual disease negativity have HSCT? Lancet Haematol. 2024;11(1):e12-e13. DOI: 1016/S2352-3026(23)00365-4
  2. Boissel N. Should patients with Ph-negative acute lymphoblastic leukaemia who reach minimal residual disease negativity have HSCT? Lancet Haematol. 2024;11(1):e13-e14. DOI: 1016/S2352-3026(23)00364-2

Your opinion matters

HCPs, what is your preferred format for educational content on the ALL Hub?
2 votes - 80 days left ...

Newsletter

Subscribe to get the best content related to ALL delivered to your inbox