 Partow Kebriaei, MD, discusses the potential shift away from transplant in acute lymphoblastic leukemia in light of ongoing advancements.

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.

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Partow Kebriaei, MD, discusses the potential shift away from transplant in acute lymphoblastic leukemia in light of ongoing advancements.

Dr Kebriaei on the Potential Shift Away From Transplant in ALL

Partow Kebriaei, MD, stem cell transplant physician, The University of Texas MD Anderson Cancer Center, discusses the eligibility criteria necessary for patients with acute lymphocytic leukemia to undergo stem cell transplantation.

Patients with ALL must be minimal residual disease (MRD) negative in order to qualify for transplant, Kebriaei explains. As a patient goes beyond first remission, the likelihood of achieving MRD negativity decreases. Generally, if a patient is in remission and morphologic is adequate, then they are fit to undergo transplant, says Kebriaei.

Now, patients are being taken in for transplant after their third, fourth, or fifth line of therapy. In the past, they would not be expected to obtain response; however, now these patients are obtaining response and, therefore, can receive a transplant, concludes Kebriaei.

Partow Kebriaei, MD, discusses the eligibility criteria necessary for patients with acute lymphocytic leukemia to undergo stem cell transplantation.

Dr. Kebriaei on Eligibility for Stem Cell Transplant in ALL

Partow Kebriaei, MD, of MD Anderson Cancer Center, discusses the SIERRA clinical trial, in which patients over the age of 55 with acute myeloid leukemia (AML) are receiving treatment with a radiolabeled anti-CD45 antibody known as Iomab-B or conventional therapy as a preconditioning regimen before allogeneic hematopoietic cell transplantation.

The targeted administration of radiation helps to treat older patients with AML, as it is a less intense therapy, notes Kabriaei. This reduced intensity is especially important for older patients, who tend to have less tolerance for toxicities. Iomab-B offers a novel therapy for this population of patients, she adds. 

View more from the 2017 BMT Tandem Meetings

Partow Kebriaei, MD, discusses the Iomab-B clinical trial for older patients with acute myeloid leukemia.

Partow Kebriaei, MD

Articles

Dr Kebriaei on the Potential Shift Away From Transplant in ALL

Dr. Kebriaei on Eligibility for Stem Cell Transplant in ALL

Dr. Kebriaei on the Iomab-B Clinical Trial