Diagnosis, prognostic factors, and assessment of ALL in adults: 2024 ELN recommendations from a European expert panel

Abstract

Working groups of the European Leukemia Net (ELN) have published several important consensus guidelines. Acute lymphoblastic leukemia (ALL) has many different clinical and biological subgroups and the knowledge on disease biology and therapeutic options is increasing exponentially. The European Working Group for Adult ALL has therefore summarized the current state of the art and provided comprehensive consensus recommendations for diagnostic approaches, biologic and clinical characterization, prognostic factors and risk stratification as well as definitions of endpoints and outcomes. Aspects of treatment, management of subgroups and specific situations, aftercare and supportive care are covered in a separate publication. The present recommendation intends to provide guidance for the initial management of adult ALL patients and to define principles as a basis for future collaborative research. -

Ponatinib as a Prophylactic or Pre-Emptive Strategy to Prevent Cytological Relapse after Allogeneic Stem Cell Transplantation in Patients with Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia Transplanted in Complete Cytological Remission

“…Therefore, in the cohort of patients we analyzed, the largest group reported to date who received maintenance with PONA after Allo-SCT, we confirm the feasibility with a favorable safety profile of PONA treatment, particularly in the prophylactic group (MRD neg), for which lower PONA doses were used [ 11 , 23 ]. What we observed confirms the favorable data already reported on post-Allo-SCT maintenance therapy with first- and second-generation TKIs and is in line with what is indicated by both the EBMT-2016 and Leukemia NET-2024 recommendations, which support the post-transplant maintenance with TKIs in Ph + ALL as both a prophylactic and pre-emptive strategy [ 1 , 2 , 6 , 8 ]. Particularly, we think that TKI prophylaxis after Allo-SCT will play a significant role in relapse prevention in those patients with high-risk characteristics before transplant (e.g., IKAROS plus or patients transplanted in CR > 1) regardless of the MRD status at Allo-SCT [ 6 ].…”

“…Several salvage options are now available to treat cytologic relapse following Allo-SCT, including drug-conjugated monoclonal antibodies (inotuzumab), bispecific antibodies (blinatumomab), and CAR-T therapy [ 1 , 2 , 4 , 5 , 7 ]. However, the molecular target therapy with TKIs remains a significant preventive option for cytological relapse post-Allo-SCT, and the EBMT provided specific recommendations on this topic in 2016 [ 8 , 9 ].…”

“…Philadelphia-positive acute lymphoblastic leukemia (Ph + ALL) still has a poor prognosis, and allogeneic hematopoietic stem cell transplantation (Allo-SCT) remains an important therapeutic option, although many advances have been made in biological knowledge and therapeutic approaches of this disease [ 1 , 2 , 3 , 4 , 5 ]. The main concerns after Allo-SCT are still transplant-related mortality and leukemia relapse prevention [ 1 , 2 , 3 , 6 , 7 ].…”

“…The use of tyrosine kinase inhibitors (TKIs) in the induction and consolidation phase of Ph + ALL therapy has improved clinical outcomes and is now considered a key component of the therapeutic program [ 1 , 2 , 3 , 4 , 5 ]. However, the appropriate administration of TKIs following Allo-SCT in Ph + ALL remains controversial, and the TKI approach (prophylactic, pre-emptive or salvage) is still heterogeneous across transplant centers, although the European Bone Marrow Transplantation Society (EBMT) published specific related recommendations in 2016 [ 6 , 7 , 8 ].…”