When Standard Chemo Isn’t the Answer in ALL: Emily K. Curran, MD

What does it really mean to treat a patient, not just their disease? For older adults diagnosed with acute lymphoblastic leukemia (ALL), that question sits at the center of every treatment decision. The toxicities are different. The priorities are different. The tools available today look almost nothing like what existed a decade ago.

Emily K. Curran, MD, is an associate professor of internal medicine at the University of Cincinnati College of Medicine, where her work centers on the care of patients with leukemia, with a particular focus on how the field can do better by its oldest and most vulnerable patients. She brings both deep clinical expertise and a frank, patient-first perspective to one of hematology’s most challenging populations.

She has been an active voice in shaping what transformation in the space looks like on the ground. She’ll tell you that classic chemotherapy’s biggest hurdles for older adults—dangerous drops in blood counts, high infection risk, nausea, and vomiting—are challenges the field now has real tools to address. But as targeted therapies and immunotherapies have entered the picture, a new layer of complexity has emerged. Agents like inotuzumab ozogamicin bring liver toxicities that patients would never anticipate. Blinatumomab keeps patients tethered to an infusion pump around the clock. As Curran puts it, “quality-of-life kind of stuff is important, too,” and she means it as a clinical imperative, not an afterthought.

She’s also a strong advocate for making minimal residual disease (MRD) testing standard of care across the board for patients who have ALL. From flow cytometry to next-generation sequencing that tracks a patient’s unique B-cell or T-cell receptor signature over time, Curran is on the front lines of figuring out how to get the most meaningful information with the least burden on patients who may not want, or can’t tolerate, repeated bone marrow biopsies.

In this conversation, she explores how she navigates the tension between doing everything possible and doing what’s right for an individual patient, the evolving toxicity landscape of newer ALL therapies, and how MRD monitoring is changing and becoming more accessible through blood-based testing. How do you approach decisions around stem cell transplant in older patients, given competing risks and evolving treatment options?