SCT Question 19
Publication/Presentation Date
11-2023
Published In/Presented At
Question 19
A 50-year-old female patient with Ph+ ALL in first remission presents for an opinion regarding allogeneic stem cell transplant in first remission. Blood and marrow is bcr abl negative (<0.01%) by PCR following therapy with Dasatinib + modified CALGB 10403 regimen. The patient has multiple donors in the registry and family. You will recommend
- Ongoing maintenance therapy with TKI
- MAC +HLA matched related donor transplant with 42 year old healthy brother
- RIC + HLA haploidentical transplant with 22 year old nulliparous daughter (+DSA)
- MAC + HLA matched unrelated donor transplant with 28 year old DPB1 permissive mismatched donor
- CD19 CAR T cell therapy
MAC- Myelo-ablative conditioning; RIC- Reduced intensity conditioning
Answer
Option 1. Conventional wisdom has been to transplant Ph+ ALL in first remission, however contemporary salvage therapies with second/third generation TKI, BiTEs, CD19-CAR T cells has altered that paradigm. The mathematically reciporcal relationship between relapse and non-relapse mortality in SCT have made it imperative to pay attention to the depth of response prior to committing to transplant. Of the conditioning regimens listed, MAC is associated with a reduction in relapse rate and is preferred. Conventionally, a relatively young HLA matched related donor will be preferred to an unrelated donor, and HLA matching is superior to HLA haploidentical transplant, however that too is being increasingly brought into question with widespread adaptation of post transplant cyclophosphamide for GVHD ppx. CAR T cell therapy is indicated for therapy of relpased ALL.
Disciplines
Medicine and Health Sciences
Department(s)
Department of Medicine
Document Type
Research