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Leukemia begins in a white blood cell in the bone marrow that undergoes a change to become a type of leukemia cell that then undergoes leukemic change

Leukemia | Causes, Diagnosis, Treatment | CURE

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Dr. Partow Kebriaei explains what patients can expect before, during and after an allogeneic stem cell transplant to treat acute lymphoblastic leukemia. 

What to Expect With a Stem Cell Transplant for Leukemia 

Allogeneic stem cell transplant is an effective treatment method for patients with acute lymphoblastic leukemia (ALL), although patients do need to live or relocate close to their treatment center and have social support at home, explained Dr. Partow Kebriaei, professor in the Department of Stem Cell Transplant and Cellular Therapy at The University of Texas MD Anderson Cancer Center.

At the Society of Hematologic Oncology (SOHO) 2024 Annual Meeting, Kebriaei discussed what patients with ALL can expect before, during and after an allogeneic stem cell transplant, which is when the patient is infused with healthy cells from a donor.

The No. 1, most important point is, when someone is diagnosed with ALL, [their care] needs to be a partnership with a transplant physician. So we will go ahead and identify a donor, and communicate and discuss with the transplant and leukemia doctor, and monitor that early response to induction therapy. Because if the patient doesn't clear their [minimal residual disease (MRD); small traces of cancer in the body after treatment] as we expect, then we want to be ready fairly quickly to go forward with transplant. So things that are required of your center to have a good outcome is very good communication between your transplant team and your leukemia physician. That's number one.

Then once we've identified a donor, again, we're monitoring closely if the patient becomes MRD-positive, or we find a genetic subtype that warrants transplant, we meet with the patient … I think for a successful transplant, we also have to think about the caretaker and the support group that the patient has, because it is an intense therapy. It's short — it's about 100 days of very intensive treatment and monitoring — but during that time, it's important for the patient to have good support. Often, patients may need to relocate, and so you want to have appropriate support and housing where you are, and then you want to be able to continue to have fairly close follow-up with your transplant physician, at least for the first two years after transplant. As we start to talk about maintenance therapies following transplant, that also then requires closer collaboration with the transplant unit or the transplant team.

For more news on cancer updates, research and education, don’t forget to 

The panel concludes its discussion with insights on challenges and unmet needs in the CML treatment landscape, highlighting ways to better support patients and caregivers.

Advancing CML Management Towards an Ideal Patient Journey

This program was made possible with support from Novartis Pharmaceuticals.

Video content above is prompted by the following:

What are the biggest unmet needs you see for CML patients today, and how do you think emerging therapies and research could address those gaps in the future?

What excites you most about the potential advancements in CML management that may be on the horizon in the next 5-10 years?

How do you envision the CML patient experience being transformed compared to today?

Experts on chronic myeloid leukemia delve into the important role of informed shared decision-making in the optimal treatment of patients with CML.

Ensuring Informed CML Care from Diagnosis Onward

As patients progress through their CML journey, how does the focus of shared decision-making evolve between the patient, caregiver, and healthcare team? What are some of the key challenges or changes you've observed in the patient, physician, and caregiver role over time?

What advice would you direct to patients and caregivers in navigating these changes?


Jorge E. Cortes, MD, details clinical scenarios that indicate a need to switch therapies for patients with chronic myeloid leukemia.

CML Treatment: Scenarios that Necessitate Switching Therapy

In which scenarios do you consider switching CML therapies, and how do you approach that conversation with patients? How does the patient experience change when switching therapies?

Claire Saxton shares insights on how physicians and caregivers can best assist patients with CML who have switched therapies.

When CML Therapy Shifts: Collaborative Approaches to Treatment Changes

Video content above is prompted by the following questions:

In your experience, how can physicians and caregivers both support patients in navigating a therapy change? Which resources can best help support patients during a treatment transition?

A panel of experts on chronic myeloid leukemia discuss common patient concerns, adverse effect considerations, and best practices for setting clear expectations.

Open Dialogue in CML Care: Setting Expectations, Managing Side Effects, and Optimizing Patient Quality of Life

What are some of the most common concerns or questions newly diagnosed CML patients may have about their initial treatment plan?

What are some common adverse effects or tolerability challenges patients may experience with their initial treatment plan?

What is your best practice to set clear expectations with your patients on what they may experience along their CML journey?

Focusing on the initiation of treatment for newly diagnosed patients with CML, Jorge E. Cortes, MD, details important factors to consider when starting treatment and Claire Saxton discusses strategies that optimize communication when considering treatment options.

Starting CML Treatment: Collaborative Choices for Better Outcomes

What are some of the most important considerations when starting treatment for a newly diagnosed patient with CML? How do age, comorbidities, and other considerations factor into the treatment plan?

Describe your best practices in helping newly diagnosed patients with CML better understand their treatment plan given the complexities involved.

In your experience, what strategies promote transparent communication around treatment considerations?

How can patients feel empowered to collaborate with their healthcare team to make an informed decision on the optimal initial treatment?


Experts on chronic myeloid leukemia discuss how caregivers can collaborate with the health care team and support newly diagnosed patients.

Empowering CML Caregivers: Strategies and Support Systems

In your work with caregivers, how have you seen them collaborate with the healthcare team to support newly diagnosed patients with CML?

Are there any specific aspects of CML management where caregiver support is particularly impactful?

Are there any resources or support groups you recommend for caregivers of patients with CML?


Knowing MRD Status Can ‘Increase Chance of Cure’ in Blood Cancer

Food and Drug Administration (FDA) approval of Kymriah

 (tisagenlecleucel) for the treatment of certain children and young adults with acute lymphoblastic leukemia, marking the first FDA-approved CAR-T cell therapy for patients with cancer.

Over the past half decade, six CAR-T cell drugs gained FDA approval for various types of leukemias, lymphomas and multiple myeloma, drastically changing the treatment paradigm of patients with blood cancer.

CAR-T cell therapy uses a patients’ own immune system to attack the cancer.

“In CAR-T cell therapy, the ‘CAR’ means chimeric antigen receptor,” 

Dr. Jordan Gauthier of Fred Hutchinson Cancer Center

 in Seattle said in an interview with CURE®. “We use one white blood cell type we call T cells and, we engineer them in the lab to express this new receptor that we call CAR … so we ‘cook’ the cells in the lab until we have enough of them, and then we put them in a bag and infuse them.”

Of note, Gauthier was a member of the Seattle Cancer Care Alliance at the time of the interview. In April, the Seattle Cancer Care Alliance and Fred Hutchinson Research Center united to become one organization known as the Fred Hutchinson Cancer Center.

The CAR-T cell therapy process starts with a blood draw so that clinicians can collect the patients’ white blood cells. The T cells will then be specially engineered to find and attack cancer. Once the killer T cells are made, they will be multiplied.

While T cells are being created, the patient will undergo conditioning chemotherapy treatment, which will kill off other immune cells, essentially “making room” for the engineered T cells to proliferate within the body.

Once the T cells are engineered and the patient has finished conditioning treatment — a process that typically takes a couple of weeks — the CAR-T cells will be infused back into the patient.

At this point, patients and their health care team must 

, namely neurotoxicity (impairment to brain function) and cytokine release syndrome (the release of too many inflammatory molecules into the blood) — both of which could be serious if not caught early.

While prior studies have shown that the majority of patients undergoing CAR-T cell therapy will experience side effects, ongoing research is trying to determine which patients are 

After patients leave the hospital after the side effect monitoring period is over, they may not need to return for more treatment, as CAR-T cell therapy often offers patients a 

 with lasting efficacy and cancer control, explained Dr. Lori A. Leslie, director of the Indolent Lymphoma and CLL Research Program at John Theurer Cancer Center in Hackensack, New Jersey.

 may qualify for CAR-T cell therapy, researchers are still studying 

, as well as investigating CAR-T cell therapy’s potential in different cancer types — 

Additionally, this summer, the FDA agreed to speed up their review of a 

 to treat rare forms of lymphoma and leukemia.

“We've started to see some patients with very long-term remissions now from CAR T. So I'm excited to see the how that field evolves in the coming years,” 

said Dr. Matthew Davids, of the Dana-Farber Cancer Institute

 in Boston, in an interview with CURE®. “I'm excited to see the how that field evolves in the coming years.”

Over the past five years, CAR-T cell therapy has improved outcomes for many patients with blood cancer. Here’s what patients need to know about the immune-based treatment.

What Is CAR-T Cell Therapy, and What Can Patients With Cancer Expect?

Cancer treatment almost always comes with side effects, regardless of how the disease is treated; chemotherapy, radiation therapy and immunotherapy all have their drawbacks.

Chemotherapy may cause hair loss, nausea and fatigue, whereas immunotherapy can cause lowered blood cell counts. But one significant side effect often occurs, paradoxically, as a result of successful treatment.

Tumor lysis syndrome is a dangerous oncological emergency that occurs when rapidly dying tumor cells release toxins into the bloodstream. This often happens as a response to effective treatment, but it can also happen spontaneously. The phenomenon tends to be more common in patients with a diagnosis of lymphoma or leukemia compared with other types of cancer. It can cause organ damage, and even be fatal. However, experts say that tumor lysis syndrome is well understood and can usually be effectively treated and prevented.

“Tumor lysis syndrome is when a patient with cancer is receiving a therapy, such as chemotherapy or other drugs, and the treatment is working so well that it’s actually breaking the tumor cells open too quickly,” explained Dr. Matthew S. Davids, associate professor of medicine at Harvard Medical School and director of clinical research in the division of lymphoma at Dana-Farber Cancer Institute in Boston, in an interview with CURE®. “And the tumor cells have toxins inside them. They have different types of salts, like electrolytes, and when those toxins and salts get spilled into the blood too quickly it overwhelms the body’s ability to clear them out.”

These electrolytes, particularly potassium and phosphate, would normally be handled by the kidneys and eliminated from the body in a patient’s urine. But, when the levels of these waste products become too great for the kidneys to handle, they can cause organ damage.

“The kidneys can’t clear out the toxins, and that can lead to serious issues for patients,” Davids continued. “This can include things like kidney issues or even heart issues. In its most serious forms, tumor lysis syndrome can even be life-threatening or fatal, but it also has milder forms where we only see these lab changes, and we can address them, and patients can still do very well.”

Notably, patients with lymphoma and leukemia are at particular risk because these blood cancers can be particularly sensitive to certain treatments and often come with a high tumor burden, meaning there are large numbers of tumor cells in a person’s body. 

One study of patients with chronic lymphocytic leukemia who were treated with the drug Venclexta (venetoclax) found that 2.7% of patients developed clinical tumor lysis syndrome, meaning these patients showed both high levels of toxins in a blood test and clinical complications, while 5.7% of patients had tumor lysis syndrome as determined by lab work.

Another study of patients with acute myeloid leukemia treated with Venclexta and either Vidaza (azacitidine) or Dacogen (decitabine) found that 18% of patients developed tumor lysis syndrome according to their bloodwork; 5% of patients developed clinical tumor lysis syndrome.

In general, research states that 3% to 7% of patients with leukemia and 4% to 11% of patients with lymphoma develop tumor lysis syndrome, though some subtypes of these cancers may have an incidence as high as 25%.

The symptoms of tumor lysis syndrome are vague and nonspecific, meaning patients are unlikely to identify it themselves, or know which signs to look out for. People with tumor lysis syndrome show symptoms like fatigue or malaise, nausea and vomiting, or sometimes flank pain (pain in one side of the body between the upper stomach area and the back), but these symptoms apply to many situations and will not immediately make a patient think of tumor lysis syndrome.

“There’s really not too much that patients will notice,” Davids noted. “At least not in the early stages.”

The only way to detect tumor lysis syndrome in its early stages is through blood testing. Usually, a patient’s care team will be aware of the risk and will conduct lab testing accordingly. When care providers know a patient is at risk for developing tumor lysis syndrome, they can take steps to prevent it with medicine and make sure the patient is properly hydrated to ensure good kidney function. Once it is diagnosed, clinicians must move quickly to treat it.

“There are really two scenarios in tumor lysis syndrome. There are the outpatients, and that’s who I see,” said Amy Goodrich, a nurse practitioner in the Hematologic Malignancies Program and research nursing manager at The Johns Hopkins Kimmel Cancer Center in Baltimore, in an interview with CURE®. “We do a very good job of preventing tumor lysis syndrome because we have time. We have time to get the medications they need and make sure they’re hydrating and getting them set up to avoid (it).”

Although tumor lysis syndrome may be dangerous and fatal if not treated early, experts note that it is a sign of successful treatment in patients with leukemia and lymphoma.  

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