Disease-Specific Indications and Outcomes

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Acute Lymphoblastic Leukemia (ALL) - Adult

Approximately 6,250 cases of acute lymphoblastic leukemia (ALL) are diagnosed annually in the United States, representing about 23% of new acute leukemias. [1]

Advances

 
Recent research in ALL provides new data for the management of ALL:
  • Patients transplanted in earlier disease stage have better outcomes than patients with advanced disease [2,3]
  • Allogeneic hematopoietic cell transplantation (HCT) is superior to autologous transplantation or chemotherapy for patients with ALL in first complete remission (CR1). The survival advantage is of greater statistical significance for patients with standard-risk ALL than for patients with high-risk ALL [4,5]
  • In the absence of an HLA-matched donor, consider cord blood transplant or autologous HCT for adult ALL in CR1 [6,7]
  • HLA-matched related and unrelated donor allogeneic HCT produces similar survival outcomes [6]
  • Reduced-intensity HCT using HLA-matched unrelated and unrelated donors is feasible and effective in older patients with B-cell acute lymphoblastic leukemia in CR1 [8]
 

Outcomes

 

Review outcomes for allogeneic transplantation in adults with ALL below. View additional ALL slides showing demographic data and transplant trends.

Data in this section have been prepared by CIBMTR® (Center for International Blood and Marrow Transplant Research), our research program.

Figure 1: ALL Survival Over Time, Unrelated HCT

ALL Survival Over Time, Unrelated HCT

Download slide "ALL Survival Over Time in Adults, Unrelated HCT"

Figure 2. ALL Survival, Unrelated Marrow HCT, by Disease Status

ALL Survival in Adults, Unrelated Marrow HCT, by Disease Status

Download slide "ALL Survival in Adults, Unrelated Marrow HCT, by Disease Status"

Figure 3. ALL Survival, Unrelated PBSC HCT, by Disease Status

ALL Survival in Adults, Unrelated PBSC HCT, by Disease Status

Download slide "ALL Survival in Adults, Unrelated PBSC HCT, by Disease Status"

Figure 4. ALL Survival, Sibling HCT, Age ≥18 Years, by Disease Status

ALL Survival in Adults, Sibling HCT, Age ≥18 yrs, by Disease Status

Download slide "ALL Survival in Adults, Sibling HCT, Age ≥18 yrs, by Disease Status"

Figure 5. ALL Survival, Unrelated HCT, Age ≥18 Years, by Disease Status

ALL Survival in Adults, Unrelated HCT, Age ≥18 yrs, by Disease Status

Download slide "ALL Survival in Adults, Unrelated HCT, Age ≥18 yrs, by Disease Status"

Referral Timing Guidelines

 

These guidelines highlight disease categories that include patients at risk for disease progression and who should be referred for a consultation for autologous or allogeneic transplantation. [9]

Transplant Consultation Guidelines: Adult ALL (adult defined as ≥40 years)

High-resolution HLA typing is recommended at diagnosis for all patients
  • Early after initial diagnosis, all patients with ALL including:
    • Primary induction failure
    • Minimal residual disease after initial therapy
    • CR1
    • First relapse
    • CR2 and beyond, if not previously evaluated

Download slide (PPT)
View complete Referral Timing Guidelines

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015; 65(1): 5-29. Access
  2. Lee SJ, Klein J, Haagenson M, et al. High-resolution donor-recipient HLA matching contributes to the success of unrelated donor marrow transplantation. Blood. 2007; 110(13): 4576-4583. Access
  3. Goldstone AH, Richards SM, Lazarus HM, et al. In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: Final results of the International ALL Trial (MRC UKALL XII/ECOG E2993). Blood. 2008; 111(4): 1827-1833. Access
  4. Gupta V, Richards S, Rowe J. Allogeneic, but not autologous, hematopoietic cell transplantation improves survival only among younger adults with acute lymphoblastic leukemia in first remission: an individual patient data meta-analysis. Blood. 2013; 121(2): 339-350. Access
  5. Ram R, Gafter-Gvili A, Vidal L, et al. Management of adult patients with acute lymphoblastic leukemia in first complete remission: systematic review and meta-analysis. Cancer. 2010; 116(14): 3447-3457. Access
  6. Oliansky DM, Larson RA, Weisdorf D, et al. 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. Biol Blood Marrow Transplant. 2012; 18(1): 18-36. Access
  7. Marks DI, Woo KA, Zhong X, et al. Unrelated umbilical cord blood transplant for adult acute lymphoblastic leukemia in first and second complete remission: A comparison with allografts from adult unrelated donors. Haematologica. 2014; 99(2): 322-328. Access
  8. Rosko AE, Wang H-L, de Lima M, et al. Reduced-intensity conditioned allograft yields favorable survival for older adults with B-cell acute lymphoblastic leukemia. Am J Hematol. 2017; 92(1): 42-49. Access
  9. NMDP/Be The Match and ASBMT Recommended Timing for Transplant Consultation, 2018. Download (PDF)