EBMT 2022 | Latest advancements in alloHSCT for ALL

Ali Bazarbachi, MD, PhD, American University of Beirut-Medical Center, Beirut, Lebanon, shares the latest developments in allogeneic hematopoietic stem cell transplantation (alloHSCT) in acute lymphoblastic leukemia (ALL). In recent years, several strategies have been developed to decrease the toxicity and non-relapse mortality (NRM) associated with alloHSCT. These include selecting patients based on age, co-morbidities, conditioning regimens, and graft source. Moreover, multiple studies have focused on reducing the post-transplant relapse rate by monitoring measurable residual disease (MRD). It has been shown that the prognostic impact of MRD is consistent across therapies, and in addition, patients who are MRD-negative have better outcomes than patients who are MRD-positive. This may be due to the fact that patients receive transplants when they are MRD-positive, which suggests achieving MRD-negativity prior to alloHSCT as an effective strategy to reduce relapse. Blinatumomab has been shown to convert approximately 80% of MRD-positive patients to an MRD-negative status after one cycle of treatment. In Philadelphia chromosome-positive (Ph+) patients, the use of tyrosine kinase inhibitors (TKIs) has enabled to double the survival rate after relapse. In addition, imatinib maintenance therapy has been shown to significantly improve leukemia-free survival (LFS) post-transplant. A study investigating the efficacy of blinatumomab in Ph- ALL reported that there were no statistically significant improvements in survival. Lastly, Prof. Bazarbachi highlights some progress in T-lineage ALL (T-ALL), where a recent study has reported that treatment with azacitidine post-transplant can lead to durable complete remission. This interview took place at the 48th Annual Meeting of the European Group for Blood and Marrow Transplantation (EBMT) 2022, which was held virtually.