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

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

Traditionally, stem cell transplant (SCT) was indicated for patients with Philadelphia chromosome—positive disease or who failed to attain a remission; however, over time the patient populations eligible for SCT has changed as more differentiated subtypes and high-risk groups were identified, explains Brammer. Additionally, more effective therapies have emerged, making SCT less necessary.

Patients with minimal residual disease—positive disease after induction or at the end of treatment appear to derive more benefit from transplant, whether or not they receive salvage therapy, says Brammer. Without SCT, those patients will likely relapse. SCT should also be considered in patients with high-risk ALL, including early T-cell precursor ALL, mixed-lineage ALL, and Philadelphia-like ALL, concludes Brammer.