scholarly journals ROLE OF ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION IN ADULT PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA

2014 ◽  
Vol 6 (1) ◽  
pp. e2014065 ◽  
Author(s):  
Federico Lussana ◽  
Alessandro Rambaldi
Keyword(s):  
Stem Cell ◽  
Acute Lymphoblastic Leukemia ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Kinase Inhibitors ◽  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
Consolidation Therapy ◽  
Hematopoietic Stem ◽  
Risk Class

Adult acute lymphoblastic leukemia (ALL) is a heterogeneous disease, due to the expression of different biological and clinical risk factors, for which allogeneic stem cell transplantation (alloHSCT) is an effective consolidation therapy. The non-relapse mortality of alloHSCT remains significantly higher compared with that of conventional chemotherapy; therefore, one of the main challenges in the care of ALL is to establish a more precise prognostic definition to select patients who could take advantage from an alloHSCT. Currently, the use of minimal residual disease following induction and early consolidation therapy has improved the prognostic accuracy in defining ALL risk class. In Philadelphia-positive ALL, the introduction of tyrosine kinase inhibitors pre and post alloHSCT appears to improve outcomes significantly and, in the absence of specifically designed clinical trials, alloHSCT remains the most effective post- remission therapy. Nowadays, alloHSCT can be performed according to different modalities encompassing the use of different conditioning regimens, as well as different donors and stem cell source, with a significant accessibility to transplant.

scholarly journals Successful treatment of relapsed/refractory B-Acute lymphoblastic leukemia with Inotuzumab ozogamicin after blinatumomab failure

2020 ◽  
Vol 9 (2) ◽  
pp. 67-70 ◽  
Author(s):  
Sergey N. Bondarenko ◽  
Anna G. Smirnova ◽  
Ivan S. Moiseev ◽  
Bella I. Ayubova ◽  
Elena V. Babenko ◽  
...  
Keyword(s):  
Stem Cell ◽  
Acute Lymphoblastic Leukemia ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
Single Cycle ◽  
Inotuzumab Ozogamicin ◽  
Hematopoietic Stem ◽  
Cell Acute Lymphoblastic Leukemia

Blinatumomab, a bispecific T-cell engaging CD3-CD19 antibody, is highly effective in patients with relapsed/refractory (R/R) B-cell acute lymphoblastic leukemia (ALL) even after allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, patients who failed with Blina have a dismal outcome. Inotuzumab ozogamicin is one of the therapeutic options after blinatumomab failure. We report a young man who exhibited bone marrow (BM) relapse of B-ALL following haploidentical stem cell transplantation (haplo-HSCT). Remission was not achieved after Blinotumomab treatment, thus Inotuzumab was administered. A complete remission with no signs of minimal residual disease was achieved after a single cycle of Inotuzumab. The second haplo-HSCT from another donor was successful. Conclusion The present case demonstrate an opportunity of successful inotuzumab therapy after failure of allo-HSCT and blinotumomab treatment.

scholarly journals Evaluation and management of measurable residual disease in acute lymphoblastic leukemia

2020 ◽  
Vol 11 ◽  
pp. 204062072091002 ◽  
Author(s):  
Iman Abou Dalle ◽  
Elias Jabbour ◽  
Nicholas J. Short
Keyword(s):  
Stem Cell ◽  
Acute Lymphoblastic Leukemia ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Kinase Inhibitors ◽  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
Frontline Treatment ◽  
Measurable Residual Disease

With standard chemotherapy regimens for adults with acute lymphoblastic leukemia, approximately 90% of patients achieve complete remission. However, up to half of patients have persistent minimal/measurable residual disease (MRD) not recognized by routine microscopy, which constitutes the leading determinant of relapse. Many studies in pediatric and adult populations have demonstrated that achievement of MRD negativity after induction chemotherapy or during consolidation is associated with significantly better long-term outcomes, and MRD status constitutes an independently prognostic marker, often superseding other conventional risk factors. Persistence of MRD after intensive chemotherapy is indicative of treatment refractoriness and warrants alternative therapeutic approaches including allogeneic stem cell transplantation, blinatumomab, or investigational therapies such as inotuzumab ozogamicin or chimeric antigen receptor T cells. Furthermore, the incorporation of novel monoclonal antibodies or potent BCR-ABL1 tyrosine kinase inhibitors, such as ponatinib into frontline treatment may have the advantage of achieving higher rates of MRD negativity while minimizing chemotherapy-related toxicities. Many studies are therefore ongoing to determine whether this strategy can improve cure rates without the need for allogeneic stem cell transplantation.

scholarly journals The effect of the minimum residual disease on the risk of relapse at allogeneic hematopoietic stem cell transplantation in children, adolescents, and young adults with acute lymphoblastic leukemia

2020 ◽  
Vol 19 (2) ◽  
pp. 93-102
Author(s):  
D. V. Prudnikov ◽  
Yu. E. Mareiko ◽  
N. P. Kirsanova ◽  
N. V. Minakovskaya ◽  
O. V. Aleinikova
Keyword(s):  
Stem Cell ◽  
Acute Lymphoblastic Leukemia ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
Hematopoietic Stem ◽  
Relapse Risk

Minimal residual disease (MRD) is an independent predictor of relapse risk for childhood acute lymphoblastic leukemia(ALL). The aim of study to investigate impact MRD by real-time quantitative polymerase chain reaction before (day –21) andat +30 ± 10, +60 ± 10, +100 ± 10, +180 ± 10, +365 ± 10 days after hematopoietic stem cell transplantation (HSCT), and PCR-chimerismon transplant outcomes children with ALL. The study was approved by the Independent Ethics Committee and the Scientific Councilof the Belarusian Research Center for Pediatric Oncology, Hematology and Immunology (Republic of Belarus). Fifty one patientswith ALL underwent allogeneic transplantation in remission (period 12.2010–12.2017, median follow-up 2,8 years). 3-years eventfreesurvival (EFS) and cumulative incidence of relapse (CIR) were 71.6 ± 17.1% and 14.3 ± 14.3% respectively for patients (n = 7)with pre-transplant MRD < 10-4 and 0% (n = 4, p = 0.0046) and 50.0 ± 29.2% (p = 0.3111) respectively for MRD ≥ 10-4. After HSCT(n = 29) 3-years EFS and CIR were 22.2 ± 13.9% and 66.7 ± 18.1% respectively for recipients (n = 9) with MRD ≥ 10-4 at leastin one analyzed point. In comparison, patients with MRD < 10-4 at all points (n = 20) had EFS and CIR 70.0 ± 10.2% (p = 0.0172)(HR = 12.3; 95% CI: 2.33–64.87; p = 0.0031), and 5.0±5.0% (p = 0.0004) (HR = 50.7; 2.5–97.5% CI: 1.60–1608.56; p = 0.0260)respectively. Patients with mixed chimerism at least in one analyzed point since day +30 to +365 hadn't significant differences OS,EFS, CIR but were worse (57.1%, 40.0% and 50.0% respectively) in comparison full chimerism patients (79.5% (p = 0.248), 71.4%(p = 0.072) and 20.0% (p = 0.070) respectively). MRD is significant predictor of relapse risk for childhood ALL at time of HSCT.MRD < 10-4 patients have significantly better EFS and CIR in comparison MRD ≥ 10-4 patients before and after HSCT.

Sign in / Sign up

Export Citation Format

Share Document