Post-Hematopoietic Cell Transplantation Relapsed Acute Lymphoblastic Leukemia: Current Challenges and Future Directions

Allogeneic hematopoietic cell transplantation (allo-HCT) represents an important and potentially curative treatment option for adult patients with acute lymphoblastic leukemia. Relapse continues to remain the most important factor influencing overall survival post allo-HCT. We discuss early identifi...

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Bibliographic Details
Published in:OncoTargets and therapy 2023-01, Vol.16, p.1-16
Main Authors: Varadarajan, Indumathy, Pierce, Eric, Scheuing, Lisa, Morris, Amy, El Chaer, Firas, Keng, Michael
Format: Article
Language:English
Subjects:
Acute lymphoblastic leukemia
Acute lymphocytic leukemia
Adults
Bone marrow
Care and treatment
Cell therapy
Chemotherapy
Chimeric antigen receptors
Chimerism
Clinical trials
Diseases
Drug approval
Flow cytometry
Hematopoietic stem cells
Immunotherapy
Laboratories
Leukemia
Lymphatic leukemia
Lymphocytes
Lymphocytes T
Medical prognosis
Mutation
Patients
Pediatrics
Relapse
Review
Stem cell transplantation
T cells
Transplantation
Transplants & implants
Vincristine
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Summary:Allogeneic hematopoietic cell transplantation (allo-HCT) represents an important and potentially curative treatment option for adult patients with acute lymphoblastic leukemia. Relapse continues to remain the most important factor influencing overall survival post allo-HCT. We discuss early identification, clinical manifestations, and management of relapsed disease. Routine evaluation of measurable residual disease (MRD) and change in donor chimerism play a crucial role in early detection. Pivotal clinical trials have led to FDA approval of multiple novel agents like blinatumomab and inotuzumab. Combining targeted therapy with cellular immunotherapy serves as the backbone for prolonging overall survival in these patients. Donor lymphocyte infusions have traditionally been used in relapsed disease with suboptimal outcomes. This review provides insight into use of cellular therapy in MRD positivity and decreasing donor chimerism. It also discusses various modalities of combining cellular therapy with novel agents and discussing the impact of chimeric antigen receptor T-cell therapy in the setting of post allo-HCT relapse both as consolidative therapy and as a bridge to second transplant.
ISSN:1178-6930
1178-6930
DOI:10.2147/OTT.S274551