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Acute lymphoblastic leukemia (ALL)

Transplant advances and outcomes

Note: Adult defined as ≥40 years

Approximately 6,250 cases of acute lymphoblastic leukemia (ALL) are diagnosed annually in the United States, representing about 23% of new acute leukemias. [1] Research shows patients transplanted in earlier disease stages have better outcomes than patients with advanced disease. [2,3]

Allogeneic hematopoietic cell transplantation (HCT) is a better treatment option for patients with ALL in first complete remission (CR1) compared to autologous transplantation or chemotherapy. Patients with standard-risk ALL have better survival outcomes than those with high-risk ALL. [4,5]

Recommended timing for transplant consultation

High-resolution HLA typing is recommended at diagnosis for all patients.

HCT consultation should take place early after initial diagnosis for patients with ALL including:

  • Primary induction failure
  • Measurable (also known as minimal) residual disease after initial therapy
  • CR1
  • First relapse
  • CR2 and beyond, if not previously evaluated

CAR-T therapy

Chimeric antigen receptor T-cell (CAR-T) therapy is a new effective treatment for hematologic malignancies. Clinical trials of CAR-T therapy targeting the B-cell marker CD19 have shown clear efficacy in multiple hematologic malignancies, specifically ALL. [8]  

 

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015; 65(1): 5-29. Access
  2. Lee SJ, Klein J, Haagenson M, et al. High-resolution donor-recipient HLA matching contributes to the success of unrelated donor marrow transplantation. Blood. 2007; 110(13): 4576-4583. Access
  3. Goldstone AH, Richards SM, Lazarus HM, et al. In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: Final results of the International ALL Trial (MRC UKALL XII/ECOG E2993). Blood. 2008; 111(4): 1827-1833. Access
  4. Gupta V, Richards S, Rowe J. Allogeneic, but not autologous, hematopoietic cell transplantation improves survival only among younger adults with acute lymphoblastic leukemia in first remission: an individual patient data meta-analysis. Blood. 2013; 121(2): 339-350. Access
  5. Ram R, Gafter-Gvili A, Vidal L, et al. Management of adult patients with acute lymphoblastic leukemia in first complete remission: systematic review and meta-analysis. Cancer. 2010; 116(14): 3447-3457. Access
  6. NMDP and ASTCT Recommended Timing for Transplant Consultation. Download PDF 
  7. National Comprehensive Cancer Network. Acute Lymphoblastic Anemia. (Version 1.2022). Access
  8. Brudno JN, Kochenderfer JN. Recent advances in car T-cell toxicity: Mechanisms, manifestations and management. Blood Reviews. 2019;34:45-55. Access