COSTEM 2021 | The role of allo-transplant for patients with ALL
Mohamad Mohty, MD, PhD, Saint-Antoine Hospital and Sorbonne University, Paris, France, gives an overview of the role of allogeneic transplantation (allo-transplant) in the treatment of patients with acute lymphoblastic leukemia (ALL), commenting on how recent advances are impacting its use. Prof. Mothy discusses novel developments in the treatment of Philadelphia-positive (Ph+) ALL, such as the use of tyrosine kinase inhibitors and bispecific antibodies, as well as talking on how better characterization of genetic features of disease and the use of novel immunotherapies such as blinatumomab and inotuzumab in earlier settings is improving outcomes for patients with Philadelphia-negative (Ph-) ALL. Prof. Mohty also discusses the use of chimeric antigen receptor T-cell (CAR-T) therapy in ALL, highlighting how this may impact the use of allo-transplantation. This interview took place at the 6th Congress on Controversies in Stem Cell Transplantation and Cellular Therapies (COSTEM), which took place virtually.
Transcript (edited for clarity)
The role of allogeneic stem cell transplantation in adult acute lymphoblastic leukemia is clearly a moving target because, for instance, when it comes to Philadelphia-positive ALL the introduction and wide use of TK inhibitors is clearly making a difference in the life of these patients. And actually, combining this with bispecific antibodies, for instance like blinatumomab, is clearly proving to be a successful treatment modality with many patients achieving MRD negativity, negative measurable residual disease...
The role of allogeneic stem cell transplantation in adult acute lymphoblastic leukemia is clearly a moving target because, for instance, when it comes to Philadelphia-positive ALL the introduction and wide use of TK inhibitors is clearly making a difference in the life of these patients. And actually, combining this with bispecific antibodies, for instance like blinatumomab, is clearly proving to be a successful treatment modality with many patients achieving MRD negativity, negative measurable residual disease. So here, one may wonder whether these patients should proceed to transplant or not.
In the Philadelphia-negative adult ALL, again the results are really improving thanks to better characterization of the genetic features of the disease, but also the use of novel or immunotherapy agents like the blinatumomab, but also inotuzumab for instance, earlier in the course of the disease. And again, we are facing the same challenge or same dilemma that if you are able to achieve sustained MRD negativity in these patients, do you really need to proceed to allotransplant bearing in mind that the MRD-negative situation disease status is probably the most important predictive factor for outcome after transplant?
So, you can see, it’s very subtle when it comes to the decision-making process. And I believe the landscape will become even more complicated with the introduction and more frequent use of CAR T-cells, the autologous CAR T-cells directed against CD19 for instance, which have been recently approved actually by FDA. And here maybe the use of these CAR T-cells is going to challenge the use of allotransplant frontline, and this is going to be extremely exciting for the future. And hopefully, thanks to the advent of all of these agents, conventional chemotherapy, TK inhibitors, bispecific antibodies, antibody-drug conjugates, but also CAR T-cells, we will be able to cure more and more of these adult ALL patients.
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