Dr. Abdul Hay on the Evolving Role of Transplant in ALL

Mohammad Maher Abdul Hay, MD, an assistant professor in the Department of Medicine, director of the Clinical Leukemia Program in NYU Langone Health’s Perlmutter Cancer Center, and associate director for research in the Bellevue Cancer Center, discusses the evolving role of transplant in acute lymphoblastic leukemia (ALL).

Transplant is still a key treatment in ALL, particularly in patients who have minimal residual disease (MRD) and in those with relapsed/refractory disease, says Abdul Hay. Blinatumomab (Blincyto) is a bispecific antibody that is being used in patients with relapsed/refractory ALL. Data from the BLAST study show that this agent is effective in patients who are MRD positive and may make them MRD negative. About 80% of patients who were MRD positive in the study became MRD negative after 1 treatment of blinatumomab.

However, the problem is that these patients will relapse. If conventional chemotherapy is used and a patient still has MRD positivity, they should go on to transplant. Blinatumomab is a bridge to take these patients to transplant, say Abdul Hay. Without transplant, there is a high risk of relapse and death.

Several factors must be considered when deciding whether a patient is eligible to undergo transplant, says Abdul Hay. Age, along with performance status, MRD positivity, and comorbidities are all taken into consideration when determining transplant eligibility, concludes Abdul-Hay.