ESH AL 2026 | Defining cure in ALL and challenges with treating older patients

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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