Dr Kebriaei on the Potential Shift Away From Transplant in ALL

Partow Kebriaei, MD, professor, Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the potential shift away from transplant in acute lymphoblastic leukemia (ALL) in light of ongoing advancements within the treatment armementarium.

There is growing evidence supporting the use of measurable residual disease (MRD) as a key metric to guide treatment intensification and consolidation decisions, particularly in the context of transplant, Kebriaei begins. MRD serves as a highly sensitive indicator of a patient’s response to therapy and allows clinicians to assess the depth of remission. When MRD levels are low, it may signal a favorable response to treatment, thereby influencing decisions about whether to proceed with a more aggressive approach, such as hematopoietic stem cell transplant, she explains.

In parallel with the use of MRD, advances in understanding the biology of ALL are helping to identify high-risk genotypic subsets, Kebriaei continues. Factors such as genotypic and karyotypic profiling of the patient’s disease are taken into account alongside MRD results, she states. Both genetic risk factors and MRD levels play an essential role in determining a patient’s likelihood of relapse, and thus help shape individualized treatment plans, Kebriaei adds.

One reason why reliance on transplants has decreased is the significant progress made in developing highly effective therapies, Kebriaei details. These therapies have demonstrated the ability to induce deep remissions early in treatment, particularly during the induction phase. As a result, a growing number of patients can potentially achieve long-term remission or even be cured without requiring a transplant, she states.

Overall, the evolving role of MRD as a marker of disease response and its incorporation into treatment strategies, coupled with new, potent therapies, reflects a broader shift toward more personalized and less invasive approaches in the treatment of ALL, Kebriaei emphasizes. As the understanding of MRD and genetic profiling continues to improve, it may become increasingly possible to tailor treatments more precisely and reduce the need for high-risk procedures like transplants for certain patients, she concludes.