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 use of the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) to guide transplant eligibility in acute lymphoblastic leukemia (ALL).

The HCT-CI is a comorbidity index, which is made up of 17 points, says Abdul-Hay. Points can be assigned to a patient based on pulmonary function test, history, diabetes status, kidney disease, and more. The lower the total score, the less likelihood the patient has of developing transplant-associated complications or mortality, says Abdul-Hay. A patient who has a low HCT-CI score and is deemed eligible for transplant should undergo transplant, adds Abdul-Hay.

In the era of graft-versus-host disease (GVHD), prevention treatment posttransplant, such as cyclophosphamide-based regimens, have decreased the incidence of GVHD, leading to an increased success rate with transplant.

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Mohammad Maher Abdul-Hay, MD, discusses the use of the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) to guide transplant eligibility in acute lymphoblastic leukemia (ALL).

Dr. Abdul-Hay on the Use of HCT-CI to Guide Transplant Eligibility 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 future of targeted therapy in acute lymphoblastic leukemia (ALL).

Conventional chemotherapy has less of a role in the treatment of patients with ALL since the advent of targeted therapy, says Abdul-Hay.

Therapeutic modalities such as bispecific T-cell engagers, monoclonal antibodies, and CAR T-cell therapy have seen rapid development in ALL, explains Abdul-Hay. Moreover, the concept of utilizing a patient’s own immune system to attack malignant cells appears promising in this setting.

Going forward, investigators will aim to improve upon the advances that have been made with targeted therapy and other novel agents in ALL, concludes Abdul-Hay.

Mohammad Maher Abdul-Hay, MD, discusses the future of targeted therapy in acute lymphoblastic leukemia.

Dr. Abdul-Hay on the Future of Targeted Therapy 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.

Mohammad Maher Abdul Hay, MD, discusses the evolving role of transplant in acute lymphoblastic leukemia.

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 treatment considerations in acute lymphoblastic leukemia (ALL).

Several studies have shown better outcomes with pediatric-based regimens in ALL, says Abdul-Hay. Even patients under the age of 50 with Philadelphia chromosome—negative disease can receive a pediatric-based regimen. If the patient is low-risk and has undetectable minimal residual disease (MRD), they should continue the regimen as consolidation and maintenance for up to 2 years, says Abdul-Hay.

If the patient doesn't respond and still has MRD positivity, blinatumomab (Blincyto) can be given followed by transplant, adds Abdul-Hay. If the patient is refractory to the initial therapy, CAR T-cell therapy or inotuzumab ozogamicin (Besponsa) can also be considered.

However, blinatumomab should be considered prior to inotuzumab ozogamicin because the latter has a risk of veno-occlusive disease (VOD) in up to 10% of patients, says Abdul-Hay. Inotuzumab ozogamicin tends to play the largest role in the treatment of transplant-ineligible patients and those who progress on blinatumomab, concludes Abdul-Hay.

Dr. Abdul-Hay on Treatment Considerations 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 use of bispecific T-cell engagers (BiTEs) in acute lymphoblastic leukemia (ALL).

BiTEs are a novel drug class that were first investigated in ALL, says Abdul-Hay. In ALL and other malignancies, the immune system cannot recognize the leukemic cells, adds Abdul-Hay. However, the drug attaches to the patient's T cells and uses the immune system to attack B cells and kill cancer cells.

Notably, BiTEs are less toxic than other therapies; however, because they hyperactivate the immune system via T-cell activation, they have a different safety profile than chemotherapy. One of the adverse events associated with these therapies is cytokine release syndrome (CRS), which occurs when the T cells and memory cells release inflammatory cytokines. Symptoms include fever and low blood pressure, depending on the grade of the CRS, says Abdul-Hay. Patients who can get past the CRS tend to tolerate the treatment fairly well, concludes Abdul-Hay.

Mohammad Maher Abdul-Hay, MD

Articles

Dr. Abdul-Hay on the Use of HCT-CI to Guide Transplant Eligibility in ALL

Dr. Abdul-Hay on the Future of Targeted Therapy in ALL

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

Dr. Abdul-Hay on Treatment Considerations in ALL

Dr. Abdul-Hay on the Use of BiTEs in ALL