New Data Spur Reconsidering Transplant in Younger ALL Patients

The treatment of acute lymphoblastic leukemia (ALL) is changing, and in the recent interview with The American Journal of Managed Care^®, Emily K. Curran, MD, associate professor of internal medicine, University of Cincinnati College of Medicine, breaks down how she talks with patients about it following the June publishing of revised guidance from the American Society of Hematology.

Curran said that many patients and their loved one arrive at their appointments believing that in order to achieve long-term remission, treatment needs to be topline aggressive, which means a stem cell transplant—usually. As recently as 5 to 10 years ago, this was the standard approach for a young, fit patient with a good donor, she explained. Her counseling has changed, however, following new data that demonstrate measurable residual disease–negativity status means patients have a better chance of doing better with chemotherapy alone vs transplant.

She paired this message with reassurance about treatment pathways to consider in the event a patient relapses. Treatments for relapsed disease are “way better” than they were before, she said, and patients can once again achieve remission, at which point transplant can be discussed. In her experience, most of her patients do not need to undergo transplant and can live long lives.

She also addressed open questions on T-cell ALL, highlighting how data from pediatric studies hint that adding bortezomib or nelarabine to pediatric-inspired regimens may improve outcomes in T-cell ALL. Confirming this is difficult because ALL is a rare disease, and T-cell ALL accounts for only about a third of those cases. The best way to answer this question is through national or international collaboration that pools resources and patients. In closing, she noted that this kind of effort is under discussion in cooperative groups and centers are working together to address this exact question.