Optimizing AlloHSCT Timing in ALL & MF: Identifying the Right Candidates

Summary for Physicians:

For ALL and other hematologic malignancies such as MF, the decision and timing for alloHSCT depend on disease-specific and patient-specific factors.

Key considerations include the following:

• Disease risk and remission status: In ALL, alloHSCT is typically considered in high-risk patients (eg, adverse cytogenetics, minimum residual disease positivity) once complete remission is achieved. For MF, high-risk disease classified per scoring systems such as the Dynamic International Prognostic Scoring System (DIPSS) and the presence of high-risk mutations may prompt early transplant.
• Prognostic scoring systems: Tools such as the DIPSS for MF or genetic risk stratification in ALL help identify candidates who are likely to benefit from transplant.
• Patient fitness and transplant eligibility: Age, comorbidities, and performance status are crucial in determining transplant suitability and timing.

Overall, alloHSCT is reserved for patients with aggressive disease features or poor prognostic indicators where curative potential justifies the associated risks.

Nelli Bejanyan reports consulting or advisory role for CareDx, Medexus Pharmaceuticals, Orca Biosystems, AlloVir, TScan Therapeutics, and Pfizer; and research funding from CRISPR Therapeutics. Everett Meyer reports sponsored research from Orca Biosciences, Kyverna; and a scientific advisor role and equity holder for GigaMune, Indee, TRACT, Jura Biosciences.Caspian Oliai reports no relevant disclosures (investigator on the Orca T trial funded by Orca Biosciences). Arpita P. Gandhi reports roles with OncLive, MJH Life Sciences, OrcaBio (research), CareDx (Advisory Board). Amandeep Salhotra reports received funding from Rigel, Bristol Myers Squibb and Orca Biosciences; and speakers bureau for Incyte and Sanofi.