ESH AL 2026 | Defining cure in ALL and challenges with treating older patients
Marlise Luskin, MD, MSCE, Dana-Farber Cancer Institute, Boston, MA, comments on the concept of a cure in acute lymphoblastic leukemia (ALL), particularly in older adult patients. She notes that the goal is to achieve a durable remission, where patients may not pass away from their leukemia but rather from other medical conditions. Dr Luskin also comments on the challenges of treating older patients with ALL and balancing the toxicity of therapies. This interview took place at the 5th How to Diagnose and Treat: Acute Leukemias meeting of the European School of Hematology (ESH AL) in Mandelieu-La Napoule, France.
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Transcript
It’s a great question. Patients ask me, patients of all types ask me, you know, when do I know I’m cured? And that’s a challenging question because there’s not necessarily a specific date where we can say, you know, there’s no chance that leukemia is coming back. But when I think about this topic and ask to speak about this topic, I think really about a durable remission...
It’s a great question. Patients ask me, patients of all types ask me, you know, when do I know I’m cured? And that’s a challenging question because there’s not necessarily a specific date where we can say, you know, there’s no chance that leukemia is coming back. But when I think about this topic and ask to speak about this topic, I think really about a durable remission. And thinking about the idea that an older adult patient that historically has had a very poor outcome with treatment for Philadelphia chromosome-negative ALL with a short survival, that now we’re talking about durable remissions, so much so that older adults may have to worry about other medical conditions in their lifetime and may not actually pass away from their leukemia. So treating older adults with ALL has been challenging historically because the tools, the traditional tools in our armamentarium have been conventional chemotherapy drugs that have a variety of toxicities, but in general are much more difficult for older adults, and older adults in particular, to tolerate. These were regimens developed for children, small children who are very resilient. And so older adults experienced really a lot of toxicities like infections and organ dysfunction and metabolic side effects, many different types of toxicities. And that really limited our ability to intensify treatment. And we were really palliative in nature, maybe trying to get a response but really not being all that ambitious with our outcomes. But now as we’ve started to develop more novel approaches for treating our older adults, we’re setting our sights more ambitiously and thinking about achieving cure as is the topic of this conversation. But still, novel agents can have toxicities as well. So with any particular patient, we really assess their fitness, their comorbidities, the side effects of the particular regimen, and try to push the efficacy as ambitiously as we can to get them the best possible outcome, but knowing when to adjust and adapt to the individual circumstances for the patient.
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Disclosures
Research Funding to Institution: Novartis, AbbVie
Advisory Boards/Consulting: Jazz, Kite, Pfizer, Novartis, AbbVie, KITE, Syndax, Servier, Autolus, Astra Zeneca
