Modern Therapy of Acute Lymphoblastic Leukemia
Although acute lymphoblastic leukemia is curable in one third of adult patients, results vary greatly on account of different clinical, immunologic, and cytogenetic/genetic characteristics. These data, along with the kinetics of response to early treatment, help establish the individual risk class with considerable accuracy, and support risk-specific treatments that should warrant optimal results with as little as possible nonrelapse mortality. Modern first-line therapy consists of standard- and high-dose chemotherapy (increasingly inspired to pediatric principles), hematopoietic stem-cell transplantation, and new targeted therapy, all integrated with the analysis of prognostic factors and the study of subclinical residual disease for key therapeutic decisions. These changes are improving long-term outcome, which in ongoing studies is expected close to 50% or greater.
- Research Article
156
- 10.1016/j.bbmt.2010.08.023
- Sep 8, 2010
- Biology of Blood and Marrow Transplantation
Superior Graft-versus-Leukemia Effect Associated with Transplantation of Haploidentical Compared with HLA-Identical Sibling Donor Grafts for High-Risk Acute Leukemia: An Historic Comparison
- Research Article
53
- 10.1016/j.bbmt.2010.05.005
- May 24, 2010
- Biology of Blood and Marrow Transplantation
NCI First International Workshop on the Biology, Prevention and Treatment of Relapse after Allogeneic Hematopoietic Cell Transplantation: Report from the Committee on Prevention of Relapse Following Allogeneic Cell Transplantation for Hematologic Malignancies
- Abstract
19
- 10.1182/blood.v122.21.552.552
- Nov 15, 2013
- Blood
Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) In Adults With Philadelphia Chromosome (Ph)-Negative Acute Lymphoblastic Leukemia (ALL): Results From The Group For Research On Adult ALL (GRAALL)
- Abstract
- 10.1182/blood-2023-179962
- Nov 2, 2023
- Blood
Allogeneic Hematopoietic Stem Cell Transplantation in Adolescents and Young Adults with Acute Lymphoblastic Leukemia - Retrospective Dual-Center Study
- Research Article
- 10.1182/blood-2025-2524
- Nov 3, 2025
- Blood
Impact of TBI, donor age, and transplant era on outcomes of allogeneic transplantation in acute lymphoblastic leukemia: Evidence from 748 patients in Latin America
- Research Article
3
- 10.1200/jco.2021.39.15_suppl.7017
- May 20, 2021
- Journal of Clinical Oncology
7017 Background: InO is a CD22-directed antibody-drug conjugate indicated for treatment of relapsed/refractory (R/R) ALL. InO has been associated with hepatotoxicity and hepatic veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS), particularly post-HSCT. Registry data (Center for International Blood and Marrow Transplant Research [CIBMTR]) was analyzed to assess toxicity in pts with ALL who received InO prior to HSCT. Methods: CIBMTR patient data are being collected for a 5-year period after US approval of InO (Aug 2017 – Aug 2022). Data from US pts age ≥18 y treated with InO who proceeded to allogeneic HSCT were included. Using interim data at 3 y, we evaluated post-HSCT outcomes, including clinical status, overall survival, transplant-related (non-relapse) mortality (NRM), relapse, death after relapse (time from HSCT to death after the first 28 d from any cause with prior relapse/progression post-HSCT), and investigator-defined adverse events, including hepatic VOD/SOS. All statistical analyses are descriptive. Results: Data accrued from 18 Aug 2017 to 17 Aug 2020 for 131 adult pts (median age 40 y) who proceeded to first allogeneic HSCT: 31% in first complete remission (CR1), 46% in CR2, 13% in ≥CR3, 5% in 1st relapse, 2% in ≥3rd relapse, and 3% in primary induction failure. A majority (70%) had transplants from peripheral blood stem cells, and 47% involved an HLA-identical sibling or other related donor. Nearly half received myeloablative conditioning regimens. Before HSCT, 36% of pts received 1 cycle of InO, 46% had 2 cycles, and 17% had ≥3 cycles. Half (48%) received InO as a single agent. Median time from last dose of InO to HSCT was 2.0 mo (range: 0.4–26.2). At time of data-lock (11 Nov 2020), post-transplant data were available for 131 pts. Outcomes for these pts are shown in the Table. Among a subgroup of adults with active R/R ALL (n = 91) at time of HSCT (median of 4 lines prior therapy), VOD/SOS incidence within 100 d of HSCT was 18%. Conclusions: Incidence of VOD/SOS after first HSCT in InO-treated pts with R/R ALL in this study was similar to the 18–19% reported in pooled analyses of 2 clinical trials among InO-treated pts with R/R ALL (Marks et al, Biol Blood Marrow Transplant 2019) and in the INOVATE study (Kantarjian et al, Lancet Haematol 2017). The NRM at 1 y of 21% (23% R/R ALL) is lower than the NRM at 1 y of 38% reported in the pooled analyses of R/R ALL InO recipients.[Table: see text]
- Research Article
102
- 10.1016/j.bbmt.2010.05.007
- May 26, 2010
- Biology of Blood and Marrow Transplantation
Conditioning with Treosulfan and Fludarabine followed by Allogeneic Hematopoietic Cell Transplantation for High-Risk Hematologic Malignancies
- Research Article
64
- 10.1016/j.bbmt.2011.07.019
- Jul 29, 2011
- Biology of Blood and Marrow Transplantation
The Role of Cytotoxic Therapy with Hematopoietic Stem Cell Transplantation in the Treatment of Adult Acute Lymphoblastic Leukemia: Update of the 2006 Evidence-Based Review
- Abstract
2
- 10.1182/blood-2022-160315
- Nov 15, 2022
- Blood
Veno-Occlusive Disease Risk and Other Outcomes in Patients with B-Cell Precursor Acute Lymphoblastic Leukemia Who Received Inotuzumab Ozogamicin and Proceeded to Hematopoietic Stem Cell Transplantation: A Registry-Based, Observational Study
- Abstract
- 10.1182/blood-2024-204066
- Nov 5, 2024
- Blood
Age ≥60 Is an Added Risk Factor for Mortality in High-Risk HCT-CI Patients Undergoing Allogeneic Stem Cell Transplant
- Research Article
29
- 10.1016/j.bbmt.2011.06.010
- Jun 30, 2011
- Biology of Blood and Marrow Transplantation
EBMT Risk Score Predicts Outcome of Allogeneic Hematopoietic Stem Cell Transplantation in Patients Who Have Failed a Previous Transplantation Procedure
- Research Article
40
- 10.1016/j.bbmt.2009.11.004
- Nov 10, 2009
- Biology of Blood and Marrow Transplantation
Low-Dose Total Body Irradiation and Fludarabine Conditioning for HLA Class I-Mismatched Donor Stem Cell Transplantation and Immunologic Recovery in Patients with Hematologic Malignancies: A Multicenter Trial
- Abstract
3
- 10.1182/blood-2021-144669
- Nov 5, 2021
- Blood
HLA-B Leader Dimorphism Impacts on Outcomes of HLA-Matched Related/Unrelated Transplantation: Analysis of the Japanese Society for Transplantation and Cellular Therapy
- Research Article
7
- 10.1016/j.bbmt.2009.03.004
- Apr 8, 2009
- Biology of Blood and Marrow Transplantation
Early (Day −7) versus Conventional (Day −1) Inception of Cyclosporine-A for Graft-versus-Host Disease Prophylaxis after Unrelated Donor Hematopoietic Stem Cell Transplantation in Children. Long-Term Results of an AIEOP Prospective, Randomized Study
- Research Article
- 10.1016/j.ijrobp.2025.10.003
- Mar 1, 2026
- International journal of radiation oncology, biology, physics
Total Body Irradiation-Based Versus Chemotherapy-Alone Myleloblative Conditioning Regimen Before Hematopoietic Allogeneic Stem Cell Transplantation in Adults With Acute Lymphoblastic Leukemia: A Multi-Institutional Study From the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC).