Dr. Vusirikala on the Role of Transplant in ALL

Madhuri Vusirikala, MD, professor of internal medicine in the Division of Hematology/Oncology at the Harold C. Simmons Comprehensive Cancer Center of UT Southwestern Medical Center, discusses the role of transplant in acute lymphoblastic leukemia (ALL).

ALL presents differently in adults compared with pediatric patients, says Vusirikala. In clinical trials, adolescents and young adults are typically those under the age of 39. While pediatric regimens are well established in B-ALL, the role of transplant is less clear.

In Philadelphia chromosome (Ph)—like ALL, targetable markers such as BCR-ABL and JAK-STAT are beginning to emerge. As such, many studies in this space are evaluating the use of ruxolitinib (Jakafi) and dasatinib (Sprycel) as up-front treatment, says Vusirikala. However, more research is needed to determine whether transplant plays a role in this patient subset. In Ph-positive ALL, transplant is commonly used, especially in those with minimal residual disease (MRD) negativity.

A study from The University of Texas MD Anderson Cancer Center evaluated the MRD status of patients with Ph—positive ALL after 3 months post treatment with hyper-CVAD and a TKI. If patients test positive for MRD, they may benefit from transplant, says Vusirikala.

At UT Southwestern Medical Center, patients with Ph—positive ALL are treated with hyper-CVAD and a TKI. At the end of induction, patients undergo a bone marrow biopsy to see whether they are in a complete molecular response. If so, patients are given maintenance therapy with 2 years of vincristine, steroids, and indefinite TKIs. If patients have MRD-positive disease, they are taken to transplant, concludes Vusirikala.