NCCN Guidelines Insights: Acute Lymphoblastic Leukemia, Version 1.2017

Brown, Patrick; Shah, Bijal; Fathi, Amir T.; Wieduwilt, Matthew J.; Advani, Anjali S.; Aoun, Patricia; Barta, Stefan K.; Boyer, Michael W.; Bryan, T.; Burke, Patrick W.; Cassaday, Ryan D.; Coccia, Peter F.; Coutré, Steven; Damon, Lloyd E.; DeAngelo, Daniel J.; Frankfurt, Olga; Greer, John P.; Kantarjian, Hagop; Klisovic, Rebecca B.; Kupfer, Gary M.; Litzow, Mark R.; Liu, Arthur; Mattison, Ryan J.; Park, Jae; Rubnitz, Jeffrey E.; Saad, Ayman; Uy, Geoffrey L.; Wang, Eunice S.; Gregory, Kristina M.; Ogba, Ndiya

doi:10.6004/jnccn.2017.0147

Cited by 73 publications

(42 citation statements)

References 74 publications

(109 reference statements)

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“…Apart from heterogeneous disease type, the variations in comparative outcomes between HIDT and MSDT could also be related to differences in disease status at the time of allo-SCT (i.e., less advanced disease or minimal residual disease [MRD]) [2,4,6,[13][14][15][16][17]. Therefore, studies have been performed in more homogenous groups [10].…”

Section: Introductionmentioning

confidence: 99%

Haploidentical donor is preferred over matched sibling donor for pre-transplantation MRD positive ALL: a phase 3 genetically randomized study

Chang¹,

Wang

et al. 2020

J Hematol Oncol

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Background: Previous reports suggest a benefit associated with haploidentical donor transplantation (HIDT) compared to matched sibling donor transplantation (MSDT) in certain contexts, and the choice of optimal candidates warrants further investigation. Methods: We designed a prospective genetically randomized study to evaluate donor options between acute lymphoblastic leukemia (ALL) patients positive for measurable residual disease (MRD) pre-transplantation who underwent HIDT (n = 169) or MSDT (n = 39). Results: The cumulative incidence of positive MRD post-transplantation was 26% (95% CI, 19-33%) and 44% (95% CI, 28-60%) for HIDT and MSDT, respectively (P = 0.043). Compared to the HIDT cohort, the MSDT cohort had a higher 3-year cumulative incidence of relapse (CIR; 47%, 95% CI, 31-63% vs. 23%, 95% CI, 17-29%; P = 0.006) and lower 3-year probability of leukemia-free survival (LFS; 43%, 95% CI, 27-59% vs. 65%, 95% CI, 58-72%; P = 0.023) and overall survival (OS; 46%, 95% CI, 30-62% vs. 68%, 95% CI, 61-75%; P = 0.039), without a difference in non-relapse-mortality (10%, 95% CI, 1-19% vs. 11%, 95% CI, 6-16%; P = 0.845). Multivariate analysis showed that HIDT is associated with a low CIR (HR = 0.364; 95% CI, 0.202-0.655; P = 0.001) and better LFS (HR = 0.414; 95% CI, 0.246-0.695; P = 0.001) and OS (HR = 0.380; 95% CI, 0.220-0.656; P = 0.001). Conclusions: HIDT is better than MSDT in view of favorable anti-leukemia activity for patients with pre-transplantation MRD positive ALL. The current study paves the way to determine that haploidentical donors are the preferred choice regardless of available matched sibling donors in a subgroup population.

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Section: Introductionmentioning

confidence: 99%

Haploidentical donor is preferred over matched sibling donor for pre-transplantation MRD positive ALL: a phase 3 genetically randomized study

Chang¹,

Wang

et al. 2020

J Hematol Oncol

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“…AL displays rapid progression and high mortality (1,5). Chemotherapy is currently the main strategy for treating AL (22). Adriamycin is a commonly used anthracycline-type chemotherapy drug that has toxic side effects when a high dose is administered (4).…”

Section: Discussionmentioning

confidence: 99%

Combination of quercetin and Adriamycin effectively suppresses the growth of refractory acute leukemia

Shi

Cui

et al. 2019

Oncol Lett

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The present study aimed to investigate the effect of combined treatment with quercetin and Adriamycin (doxorubicin) on the development of refractory acute leukemia. Primary leukemic cells were isolated from patients with refractory drug-resistant acute leukemia. The Cell Counting Kit-8 assay was used to detect the proliferation of cells treated with a range of doses of Adriamycin, quercetin and a combination of the two drugs. Non-irradiated mice were used to establish a T cell acute lymphoblastic leukemia (T-ALL) model, which was subsequently treated with Adriamycin, quercetin and a combination of the two drugs. The survival time was recorded, and white and red blood cells and platelets in mouse peripheral blood were counted. Superoxide dismutase (SOD) activity and malondialdehyde (MDA) content of cardiac tissues were measured as indicators of oxidative stress and damage. Proliferation of primary leukemic cells was reduced by Adriamycin depending on the dose (0.06, 0.6 or 6 µg/ml) and treatment duration (24, 48 or 72 h) compared with the vehicle treated group. Co-treatment with quercetin achieved a similar suppression of leukemic cell proliferation when a lower dose of Adriamycin (0.03, 0.3 or 3 µg/ml) was administered for the same duration. The survival of non-irradiated mice with T-ALL was improved by co-treatment with a high dose of Adriamycin and quercetin compared with either treatment alone. Compared with treatment with Adriamycin alone, the combined treatment with Adriamycin and quercetin significantly enhanced the SOD activity and reduced the MDA content in the heart. Therefore, quercetin may enhance the effects of Adriamycin on refractory acute leukemia.

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“…Additionally, trials of several new therapies such as inotuzumab [7] and tisagenlecleucel [8] are evaluating MRD negativity as a secondary endpoint in addition to complete remission. NCCN and the European Society for Medical Oncology (ESMO) both highly recommend that MRD testing be a mandatory part of post-induction follow-up care for appropriate risk stratification [6,9]. Conventional recommendations are for patients with persistent MRD to seek out allogeneic hematopoietic stem cell transplant (alloHSCT) [10].…”

Section: Discussionmentioning

confidence: 99%

“…A subset of patients undergoing alloHSCT with MRD can become MRD negative; however, undergoing alloHSCT in the presence of MRD has demonstrated a worse outcome compared to MRD negativity at time of transplant [10][11][12]. NCCN also offers MRD-directed therapy with blinatumomab as a treatment option [6].…”

Section: Discussionmentioning

confidence: 99%

“…Detection of MRD is associated with shorter event-free and overall survival compared to patients without MRD presence [5]. The National Comprehensive Cancer Network (NCCN) released official guidelines [6] about the necessity for monitoring MRD levels for ALL patients in complete remission. NCCN provides treatment options for patients with persistent MRD, including but not limited to blinatumomab, allogeneic stem cell transplant, and multi-agent chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Cross-sectional physician survey on the use of minimal residual disease testing in the management of pediatric and adult patients with acute lymphoblastic leukemia

et al. 2018

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NCCN Guidelines Insights: Acute Lymphoblastic Leukemia, Version 1.2017

Cited by 73 publications

References 74 publications

Haploidentical donor is preferred over matched sibling donor for pre-transplantation MRD positive ALL: a phase 3 genetically randomized study

Haploidentical donor is preferred over matched sibling donor for pre-transplantation MRD positive ALL: a phase 3 genetically randomized study

Combination of quercetin and Adriamycin effectively suppresses the growth of refractory acute leukemia

Cross-sectional physician survey on the use of minimal residual disease testing in the management of pediatric and adult patients with acute lymphoblastic leukemia

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