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Review
. 2024 Sep 17.
doi: 10.1111/bjh.19682. Online ahead of print.

A critical review of management of allogeneic transplant-eligible adults with Ph+ acute lymphoblastic leukaemia

Naranie Shanmuganathan  1   2 , Andrew Grigg  3
Affiliations
Review

A critical review of management of allogeneic transplant-eligible adults with Ph+ acute lymphoblastic leukaemia

Naranie Shanmuganathan et al. Br J Haematol. .

Abstract

Acute lymphoblastic leukaemia (ALL) in 20%-30% of adult patients contains the Philadelphia (Ph+) chromosome. Historically, Ph+ ALL denoted a markedly inferior outcome and long-term survival in the absence of an allograft was uncommon. However, the advent of targeted therapy directed against the BCR::ABL1 fusion protein with various tyrosine kinase inhibitors (TKIs) has markedly improved the prognosis, resulting in a number of treatment controversies in allograft-eligible patients. Which is the best TKI to use in induction? What is the clinical relevance of the subdivision of Ph+ ALL into multilineage vs lymphoid types? Do all patients in first morphological complete remission (CR1) after induction and consolidation with chemotherapy/TKI require an allograft? If not, what risk factors predict a poor outcome without an allograft? Can chemotherapy-free approaches, such as blinatumomab in conjunction with more potent TKIs, obviate the need for an allograft in high-risk patients? What is the best strategy to deal with persistent or emerging minimal residual disease both pre- and post-transplant? Is maintenance TKI indicated in all patients post allograft? Can salvage therapy and a subsequent allograft cure patients who relapse after not being transplanted in CR1? This manuscript reviews the latest data influencing contemporary management and discusses these controversies.

Keywords: BCR::ABL1; MRD; acute leukaemia; stem cell transplantation.

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References

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