Predictive Factors and Outcomes after Allogeneic Stem Cell Transplantation for Adults with Acute Lymphoblastic Leukemia in Brazil

Silva, Wellington F; Cysne, D. N.; Kerbauy, Mariana Nassif; Colturato, Iago; Maia, Ana Carolina Arrais; Tucunduva, Luciana; Barros, George Maurício Navarro; Colturato, Vergílio; Hamerschlak, Nelson; Rocha, Vanderson

doi:10.1016/j.jtct.2022.07.025

Cited by 3 publications

(1 citation statement)

References 47 publications

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“…The decision of whether to proceed with alloSCT after achieving CR in Ph+ ALL should consider several factors: (i) clinical eligibility for the procedure, considering that many patients with this disease may be older or have comorbidities that increase toxicity; (ii) the achievement of CMR; (iii) the presence of higher-risk genetic features, such as IKZF1plus; (iv) the availability of newer-generation TKIs, like ponatinib or monoclonal antibodies (blinatumomab or inotuzumab), in the case of disease progression or loss of CMR; (v) access to the monitoring of the BCR-ABL1 transcript and MRD; And (vi) local toxicity and mortality rates associated with alloSCT, especially in LMICs [6,86,87]. Retrospective reports indicate that patients who have undergone alloSCT should receive TKI therapy post-procedure for at least 2-3 years [88,89].…”

Section: Allogeneic Stem-cell Transplantation and Alternative Approachesmentioning

confidence: 99%

How to Manage Philadelphia-Positive Acute Lymphoblastic Leukemia in Resource-Constrained Settings

Silva,

Rego

2023

Cancers

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Recent studies have indicated that more than half of adult patients newly diagnosed with Ph+ ALL can now achieve a cure. However, determining the most suitable protocol for less-resourced settings can be challenging. In these situations, we must consider the potential for treatment toxicity and limited access to newer agents and alloSCT facilities. Currently, it is advisable to use less intensive induction regimens for Ph+ ALL. These regimens can achieve high rates of complete remission while causing fewer induction deaths. For consolidation therapy, chemotherapy should remain relatively intensive, with careful monitoring of the BCR-ABL1 molecular transcript and minimal residual disease. AlloSCT may be considered, especially for patients who do not achieve complete molecular remission or have high-risk genetic abnormalities, such as IKZF1-plus. If there is a loss of molecular response, it is essential to screen patients for ABL mutations and, ideally, change the TKI therapy. The T315I mutation is the most common mechanism for disease resistance, being targetable to ponatinib. Blinatumomab, a bispecific antibody, has shown significant synergy with TKIs in treating this disease. It serves as an excellent salvage therapy, aside from achieving outstanding results when incorporated into the frontline.

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Section: Allogeneic Stem-cell Transplantation and Alternative Approachesmentioning

confidence: 99%

How to Manage Philadelphia-Positive Acute Lymphoblastic Leukemia in Resource-Constrained Settings

Silva,

Rego

2023

Cancers

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Patterns and prognostic impact of CNS infiltration in adults with newly diagnosed acute lymphoblastic leukemia

Perruso,

Velloso,

Rocha

et al. 2024

Ann Hematol

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Donor matters: Donor selection impact on hematopoietic stem cell transplantation outcomes in Hispanic patients with B-cell acute lymphocytic leukemia: Insights from a myeloablative HSCT study

Ashouri,

Ginosyan,

Chu

et al. 2024

Leukemia Research

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Predictive Factors and Outcomes after Allogeneic Stem Cell Transplantation for Adults with Acute Lymphoblastic Leukemia in Brazil

Cited by 3 publications

References 47 publications

How to Manage Philadelphia-Positive Acute Lymphoblastic Leukemia in Resource-Constrained Settings

How to Manage Philadelphia-Positive Acute Lymphoblastic Leukemia in Resource-Constrained Settings

Patterns and prognostic impact of CNS infiltration in adults with newly diagnosed acute lymphoblastic leukemia

Donor matters: Donor selection impact on hematopoietic stem cell transplantation outcomes in Hispanic patients with B-cell acute lymphocytic leukemia: Insights from a myeloablative HSCT study

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