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Acute lymphoblastic leukemia (ALL) - pediatric

Transplant advances and outcomes

Note: Pediatric defined as <39 years.

Approximately 6,000 individuals are diagnosed with acute lymphoblastic leukemia (ALL) each year in the United States. Children and adolescents younger than 20 years comprise about 54% of these cases, making ALL the most common type of pediatric cancer. [1]

ALL is the most common indication for allogeneic hematopoietic cell transplantation (HCT) in patients <18 years with hematological malignancies. [2] Research suggests that allogeneic HCT is recommended for pediatric ALL patients who experience primary induction failure, but subsequently achieve a first complete remission (CR1). Human leukocyte antigen (HLA) matched related and matched unrelated HCT provide equivalent outcomes. [3]

Recommended timing for transplant consultation

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

Age <15 years

  • Infant at diagnosis
    • unfavorable genetics
    • age <3 months with any WBC, or <6 months with WBC>300,000 at presentation
  • Primary induction failure
  • Presence of measurable (also known as minimal) residual disease after initial therapy
  • High/very high-risk CR1, including:
    • Philadelphia chromosome positive slow-TKI responders or with IKZF1 deletions; Philadelphia-like
    • iAMP21
    • 11q23 rearrangement
  • First relapse
  • CR2 and beyond, if not previously evaluated
  • Chimeric Antigen Receptor Therapy (CAR-T)

Age 15-39 Years

  • Primary induction failure
  • Presence of measurable (also known as minimal) residual disease after initial therapy
  • High/very high-risk CR1 including:
    • Philadelphia chromosome positive or Philadelphia-like
    • iAMP21
    • 11q23 rearrangement
  • B-cell with poor-risk cytogenetics
  • First relapse
  • CR2 and beyond, if not previously evaluated

 

References

  1. SEER Stat Fact Sheets: Acute Lymphocytic Leukemia. Accessed 1 November, 2017. Access
  2. D'Souza A, Fretham C. Current Uses and Outcomes of Hematopoietic Cell Transplantation (HCT): CIBMTR Summary Slides, 2017. Available at: http://www.cibmtr.org
  3. Oliansky DM, Camitta B, Gaynon P, et al. Role of cytotoxic therapy with hematopoietic stem cell transplantation in the treatment of pediatric acute lymphoblastic leukemia: Update of the 2005 Evidence-Based Review. Biol Blood Marrow Transplant. 2012; 18(4): 505-522. Access
  4. NMDP/Be The Match and ASTCT Recommended Timing for Transplant Consultation. Download PDF
  5. National Comprehensive Cancer Network. Pediatric Acute Lymphoblastic Anemia. (Version 1.2023). Access
  6. Determine Efficacy and Safety of CTL019 in Pediatric Patients With Relapsed and Refractory B-cell ALL (ELIANA) (ClinicalTrials.gov identifier: NCT02435849). Access