Dr. Litzow on Transplants in Patients with ALL

Mark R. Litzow, MD, chair, ECOG-ACRIN Leukemia Committee, professor of medicine, Division of Hematology, Mayo Clinic, discusses the role of transplant in patients with acute lymphoblastic leukemia (ALL).

Litzow says the role of transplant in ALL has evolved over the years. The advent of pediatric-intensive chemotherapy regimens has demonstrated improved outcomes in younger patients compared to traditional chemotherapy regimens. Benefit has also been seen in patients up to 40-45 years old, Litzow says, but patients older than 40-45 years did not tolerate the pediatric-intensive chemotherapy regimens as well, due to complications and treatment-related mortality.

These results seem so promising in younger patients that they may not need transplant in first remission. However, younger patients with high-risk features, such as high white blood cell count or adverse cytogenetics, may still benefit from transplant, Litzow says.

Litzow says it is known that outcomes are worse in older patients who undergo chemotherapy treatment. However, reduced-intensity conditioning transplant regimens are in development and have demonstrated encouraging results in older patients. This will allow these patients to get through transplant more easily while more effectively controlling their leukemia, Litzow says.