Dr. Brammer on the Role of Stem Cell Transplant in ALL

Jonathan E. Brammer, MD, assistant professor, internal medicine, The Ohio State University Comprehensive Cancer Center—–James, discusses the role of stem cell transplant in acute lymphoblastic leukemia (ALL).

Historically, the utility of allogeneic stem cell transplant (ASCT) in ALL was debated because its impact on survival was unknown, explains Brammer.

However, a study led by Nathalie Dhédin, MD, which evaluated two prospective clinical trials—–(NCT00222027) and (NCT00327678)––demonstrated a survival benefit with ASCT in patients who do not achieve minimal residual disease (MRD) negativity following treatment. Notably, the benefit was reported regardless of ALL subtype, says Brammer.

Patients who are MRD negative after chemotherapy and who do not have a high-risk subtype of ALL may not need transplant, says Brammer. However, patients should be counseled on an individualized basis to determine the optimal treatment strategy.

Notably, stem cell transplant has become safer and more effective for older patients with ALL. Historically, only patients ≤60 years old were considered transplant eligible. With reduced intensity conditioning, patients up to 75 years old may be eligible for transplant, says Brammer.

Finally, improved techniques have made it possible to use mismatched donors for some patients, concludes Brammer.