ASH 2025 | Predictors of outcomes with and without alloSCT after first salvage therapy for R/R B-ALL

So, you know, the paradigm really has been for patients with relapsed/refractory B-cell ALL that you need to get them into remission and send them to transplant for them to have any meaningful chance of long-term survival. But, you know, we’ve presented some data previously that, for example, with a low-intensity chemo regimen, our mini-hyper-CVD-based regimen with inotuzumab and blinatumomab, that there did not seem to be a difference between patients who underwent consolidative transplant versus didn’t. So we wanted to dig into these data and get a better sense of who are the patients who might benefit from transplant versus don’t. 

So we took a large cohort of patients treated with either an inotuzumab or blinatumomab-based regimen in first salvage. And we looked at predictors of outcomes and the benefit of transplant. And we identified patients who have what we call higher-risk disease in this context. Those patients who either don’t achieve an early flow MRD negativity with their salvage regimen, or those patients who had a short duration of first remission, like less than 12 months, those patients clearly benefit from transplant as consolidative therapy even if they go into remission. 

In contrast, patients who we call lower risk patients in first salvage, those patients who achieve early flow MRD negativity and were either refractory maybe to just one or two cycles of prior therapy or had a late relapse over 12 months, those patients did not benefit from transplant, and they had actually excellent outcomes whether you sent them to transplant or not. 

So we feel these data will be helpful to inform clinicians in terms of what they should do as salvage therapy or consolidative therapy for their patients in salvage. My own practice now is for patients in first salvage. If they met those criteria, if they had good early MRD clearance and they were either a late relapse or maybe just refractory to initial therapy, we don’t send those patients to transplant based on these data. That said, we do try to do CAR T-cell consolidation for these patients. And I think that there’s going to be emerging data about the benefit of CAR T-cell consolidation, hopefully in the future. And I think that’s what we’ll likely do for these patients rather than transplant in the future.

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