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Hematopoietic Cell Transplantation for Philadelphia Chromosome Negative Adult Acute Lymphoblastic Leukemia in the Modern Era of Immune Therapy

  • Stem Cell Transplantation (R Maziarz, Section Editor)
  • Published:
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Abstract

Purpose of Review

This review will discuss the data and controversies related to HCT in the front-line and relapsed/refractory setting in the context of newly available targeted immunotherapies.

Recent Findings

Recent studies in adult Ph-negative ALL support the use of measurable residual disease (MRD) response to front-line therapy to guide consolidation. As such, most MRD-negative patients do not require front-line HCT. Blinatumomab benefits patients with B-ALL with MRD+ complete response (CR) and can be used as a bridge to HCT; whether HCT is still required in this setting is an area of ongoing inquiry. Blinatumomab and inotuzumab result in high rates of MRD negative CR in adults with relapsed/refractory ALL and allow more patients with relapsed disease to receive HCT. Chimeric antigen receptor T cell (CAR-T) therapies may serve as a bridge to HCT or as a stand-alone therapy for relapsed/refractory patients; data suggests there may be greater benefit to consolidating CAR-T with HCT in HCT-naïve adults.

Summary

The decision to incorporate consolidative allogeneic HCT into front-line therapy should be primarily guided by MRD status and the ALL regimen utilized. Targeted immunotherapies result in high MRD-negative CR rates, allowing more adults with relapsed/refractory ALL to be successfully bridged to HCT; early incorporation of these therapies may also prove valuable in reducing the need for HCT in the front-line setting by increasing MRD negative CR rates.

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Authors and Affiliations

  1. Division of Hematology/Oncology, Stanford University, Stanford, CA, USA

    Ilana Yurkiewicz

  2. Division of Blood and Marrow Transplantation, Stanford University, 300 Pasteur Drive H0144, Stanford, CA, 94305, USA

    Juliana Craig & Lori Muffly

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  1. Ilana Yurkiewicz
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Correspondence to Lori Muffly.

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Yurkiewicz, I., Craig, J. & Muffly, L. Hematopoietic Cell Transplantation for Philadelphia Chromosome Negative Adult Acute Lymphoblastic Leukemia in the Modern Era of Immune Therapy. Curr Hematol Malig Rep 15, 187–193 (2020). https://doi.org/10.1007/s11899-020-00579-0

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