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ALLOGENEIC TRANSPLANTATION FOR ALL Making the case for transplant in CR1 Amelia Langston, MD Professor of Hematology Oncology Director and Section Chief, Bone Marrow Transplant Program Emory University School of Medicine Disclosure I have
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Making the case for transplant in CR1
Amelia Langston, MD Professor of Hematology‐Oncology Director and Section Chief, Bone Marrow Transplant Program Emory University School of Medicine
I have nothing relevant to this presentation to disclose
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Balancing the risks and benefits…
Disease control
not the answer
residual disease (MRD) allow a risk stratified approach to who needs a transplant
we can get more relapsing patients into CR2 and on to transplant
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for ALL
applicable) now than it was 20 years ago
support offering transplant to adults with ALL in CR1 if a matched donor is available and the patient is fit
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1980-84 2000-2004
Improvements in
with increasing age D Pulte et al. Blood 2009
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AH Goldstone et al. Blood 2008
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72% “compliance” 92% “compliance” AH Goldstone et al. Blood 2008
Standard chemotherapy was superior to autologous transplantation
AH Goldstone et al. Blood 2008
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Patients with a donor had superior overall survival
Patients in no donor arm censored at the time of autoSCT AH Goldstone et al. Blood 2008
High risk definition – Age > 35 yrs – WBC ≥ 100,000 for B lineage – WBC ≥ 30,000 for T lineage ALL Standard risk patients derived the greatest benefit from transplantation due to more NRM in the high risk cohort
AH Goldstone et al. Blood 2008
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Life beyond relapse?
Only 18% of pts made it to transplant
5 year survival post relapse was only 7% for the group as a whole
AK Fielding et al. Blood 2008
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that used in most centers today, particularly considering that many younger pts receive pediatric‐like regimens
transplants from matched related donors
– What about RIC and nonmyeloablative regimens, esp. for
– What about matched unrelated donors?
AH Goldstone et al. Blood 2008
Meta-Analysis of Adult ALL studies
Transplant vs no Transplant in CR1
J Pidala et al. Cochrane Collaboration, 2006
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Decision Analysis of HSCT vs Chemo for ALL in CR1
S Kako et al. Leukemia 2010
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UKALLXII/ECOG 2993 bridged the imatinib era
AK Fielding et al. Blood 2014
Post‐remission therapy in the imatinib cohort
Allo‐transplant still produces the best outcomes
AK Fielding et al. Blood 2014
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MRD status assessed by PCR at CR is highly predictive
and not transplanted in CR1
F Ravandi et al. Blood 2013
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Matched related donor and matched unrelated donor transplants in ALL‐CR1 produce similar outcomes
MG Kiel et al. JCO 2004
Conclusions
with ALL
from transplantation
transplant in CR2
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