Summary of recommendations for transplant consolidation in adult ALL
| Indication for transplant* . | |
|---|---|
| *Early referral of high-risk patients for prompt donor search and personalized/collaborative decision-making is critical | |
| Immunophenotype | Early T-cell precursor |
| Karyotype | Complex karyotype; low hypodiploid (32–39 chromosomes); near haploid (24–31 chromosomes) |
| Unfavorable molecular genetic profile | IKZF1; BCR::ABL1-like (Ph-like); KMT2A rearranged; MEF2D rearranged; MYC rearranged; TP53; iAMP21 |
| Slow response to therapy | Time to morphologic CR >4 weeks |
| Persistent MRD post-induction using flow or NGS | |
| No added benefit to transplant consolidation . | |
| BCR::ABL1 rearranged (Ph+) • With incorporation of TKI therapy, studies suggest no benefit to HCT in patients who develop prompt, deep response AND have no evidence for unfavorable molecular features. | |
| Absence of high-risk molecular genetic features AND prompt, deep response to induction therapy. | |
| Role of transplant consolidation not clear . | |
| Consolidation post-CAR-T therapy • Patients with very high risk features and patients with evidence for MRD following CAR-T likely benefit from HCT consolidation; toxicity from extensive prior therapy may result in adverse survival in other patients. | |
| Indication for transplant* . | |
|---|---|
| *Early referral of high-risk patients for prompt donor search and personalized/collaborative decision-making is critical | |
| Immunophenotype | Early T-cell precursor |
| Karyotype | Complex karyotype; low hypodiploid (32–39 chromosomes); near haploid (24–31 chromosomes) |
| Unfavorable molecular genetic profile | IKZF1; BCR::ABL1-like (Ph-like); KMT2A rearranged; MEF2D rearranged; MYC rearranged; TP53; iAMP21 |
| Slow response to therapy | Time to morphologic CR >4 weeks |
| Persistent MRD post-induction using flow or NGS | |
| No added benefit to transplant consolidation . | |
| BCR::ABL1 rearranged (Ph+) • With incorporation of TKI therapy, studies suggest no benefit to HCT in patients who develop prompt, deep response AND have no evidence for unfavorable molecular features. | |
| Absence of high-risk molecular genetic features AND prompt, deep response to induction therapy. | |
| Role of transplant consolidation not clear . | |
| Consolidation post-CAR-T therapy • Patients with very high risk features and patients with evidence for MRD following CAR-T likely benefit from HCT consolidation; toxicity from extensive prior therapy may result in adverse survival in other patients. | |