Today we are outlining the key recommendations made in the American Society of Hematology (ASH) guideline on acute lymphoblastic leukemia (ALL), Management of Relapsed/Refractory Disease in Adolescents and Young Adults with ALL. Adolescents and young adults (AYA) with relapsed or refractory acute lymphoblastic leukemia represent a distinct population that faces complex clinical and psychosocial needs, often experiencing increased toxicity, higher treatment resistance, and are at a life stage shaped by unique priorities.
ASH developed evidence-based guidelines to guide management decisions for AYA with relapsed or refractory ALL, which resulted in eight recommendations. View the full-text guideline for the most thorough explanation of the following highlights.
- Blinatumomab is recommended over chemotherapy for AYAs with relapsed/refractory B-cell ALL.
- Inotuzumab is recommended over chemotherapy for AYAs with relapsed/refractory B-cell ALL.
- The guideline suggests further consolidation with allogeneic hematopoietic stem cell transplantation for HSCT-naïve AYAs with relapsed B-cell ALL who achieve a second remission using autologous CD19 CAR-T products.
- The guideline suggests allogeneic hematopoietic stem cell transplantation for AYAs with relapsed B-cell ALL over chemotherapy alone.
- The guideline suggests myeloblative conditioning over chemotherapy alone for AYAs who have relapsed/refractory ALL with allogeneic hematopoietic stem cell transplantation.
- The guideline recommends that AYAS with isolated CNS relapse of ALL receive CNS-directed therapy.
- The guideline recommends against AYAs with isolated CNS relapse of ALL receiving CNS radiation as sole management.
- The guideline suggests a nelarabine-containing regimen for AYAs with relapsed/refractory T-cell ALL.
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