EBMT 2022 | AlloHSCT in Ph+ ALL
Arnon Nagler, MD, Chaim Sheba Medical Center, Tel-Aviv, Israel, discusses transplant decisions for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL). Currently, data from several studies support skipping or postponing stem cell transplantation (SCT) to the second complete remission (CR2) if the patient is MRD-negative. Prof. Nagler explains that the introduction of tyrosine kinase inhibitors (TKIs) and the use of measurable residual disease (MRD) monitoring have significantly improved the outcomes of patients with Ph+ ALL. This interview took place at the 48th Annual Meeting of the European Group for Blood and Marrow Transplantation (EBMT) 2022, which was held virtually.
Transcript (edited for clarity)
So the answer, most probably yes. There is the Italian data and the Spanish data that, if you go in the studies that are MRD-driven, you can, maybe, I will not say avoid, but postpone the transplant to CR2. So, patients that are MRD-negative, of course, if they are screened as MRD negative, you can continue with the consolidation and maintenance therapy with TKI, and you can skip the transplant in Philadelphia-positive ALL and postpone the transplant if the patient relapses or becomes MRD-positive, so in second CR2, or any indication a patient becomes MRD-positive...
So the answer, most probably yes. There is the Italian data and the Spanish data that, if you go in the studies that are MRD-driven, you can, maybe, I will not say avoid, but postpone the transplant to CR2. So, patients that are MRD-negative, of course, if they are screened as MRD negative, you can continue with the consolidation and maintenance therapy with TKI, and you can skip the transplant in Philadelphia-positive ALL and postpone the transplant if the patient relapses or becomes MRD-positive, so in second CR2, or any indication a patient becomes MRD-positive. So again, not everybody agrees with this, but it seems that this is where the field is going. And Philadelphia-positive ALL, that was a disease that, again, had devastating results or much poorer results than Philadelphia-negative ALL, because of the TKI and because of MRD. By monitoring for the BCR-ABL in Philadelphia ALL, before it was in Philadelphia-negative ALL, you can maybe postpone the transplant in this disease category. And in all recent studies, including the acute leukemia and other registry studies, the results of patients with Philadelphia-positive ALL are now better than patients which are Philadelphia-negative ALL, due to the MRD and the TKI, they are receiving pre and post-transplant, or through skipping the transplant.
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