EBMT 2024 | Managing relapsed ALL: the role of novel cellular therapies & importance of conditioning regimens
In this video, Christina Peters, MD, St. Anna Children’s Hospital, Vienna, Austria, discusses the challenge of managing relapse in patients with acute lymphoblastic leukemia (ALL). Dr Peters first comments on the important role of allogeneic stem cell transplant (allo-SCT), as well as CAR-T cells and NK-cell therapy for these patients. Following this, Dr Peters highlights the impact that conditioning regimens have on patient outcome, which has been demonstrated in the FORUM trial (NCT01949129). This interview took place at the 50th Annual Meeting of the EBMT in Glasgow, Scotland.
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Transcript
So relapse in ALL is still a high risk situation for children with acute lymphoblastic leukemia. But a lot of progress has been made over the last 20 years, I would say. And nowadays we can already very early in the treatment course, identify patients who are at very high risk for relapse. Those might undergo nowadays not only allogeneic stem cell transplantation, but also other cell therapies like for instance, CAR T-cell therapy, but for instance also NK-cell therapy...
So relapse in ALL is still a high risk situation for children with acute lymphoblastic leukemia. But a lot of progress has been made over the last 20 years, I would say. And nowadays we can already very early in the treatment course, identify patients who are at very high risk for relapse. Those might undergo nowadays not only allogeneic stem cell transplantation, but also other cell therapies like for instance, CAR T-cell therapy, but for instance also NK-cell therapy. And in the relapse situation, except for the very late isolated bone marrow relapses, allotransplant still has an important role to rescue patients after a relapse. The FORUM trial, For Omitting Radiation Under Majority age, has shown that the conditioning regimen, besides the remission status, impacts on the outcome of the patients. Because what we have demonstrated over the last eight years is that total body irradiation in combination with etoposide, is superior to so-called chemo conditioning regimen, which consisted in our prospective randomized trial of a combination of fludarabine thiotepa and either busulfan or treosulfan. The second important issue is it is better to have a suitable sibling or unrelated donor, because here the outcome results are much better compared to a haploidentical donor transplant in relapsed ALL.
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