Leukemia Service and Cellular Therapeutics Center
Memorial Sloan Kettering Cancer Center
New York, New York
Jae H. Park, MD, has disclosed that he has received consulting fees from Allogene, Amgen, AstraZeneca, Autolus, GlaxoSmithKline, Incyte, Kite, Novartis, and Takeda.
The clinical management of patients with acute lymphoblastic leukemia (ALL) is becoming increasingly complex. The realities of current clinical practice require clinicians to consider not only clinical factors such as patient age and comorbidities but also specific disease characteristics including molecular subtype, cytogenetic risk factors, prior treatments, and duration of previous remissions when planning a treatment strategy from multiple different and reasonable options. The complexity of care seems to be accelerating as the number of available treatment options continues to expand, each with a distinct mechanism of action and safety profile. Practice guidelines are useful to help with reimbursement and can provide a general treatment plan for broad groups of patients with ALL, listing multiple therapy choices based on the available levels of evidence. However, these guidelines are less useful for selecting therapy for specific patients in practice, where many variables must be considered so that the treatment plan can be individualized to that patient.
To help guide appropriate treatment selection, my colleagues and I developed an online Interactive Decision Support Tool for adult patients with B-cell ALL. This tool provides treatment consultation and recommendations from 5 experts for more than 200 defined patient case scenarios. As a participant, you are able to enter key patient and disease characteristics to define the different patient scenarios in which you are interested (Figure 1).
Figure 1. Entering patient and disease characteristics into the tool.
Once the information for your particular patient scenario has been defined, you are able to indicate your planned treatment choice. After entering your treatment choice, you will be shown the individualized treatment recommendations from all 5 of the experts for that specific patient scenario, allowing you to compare them with your planned therapy (Figure 2).
Figure 2. Expert treatment recommendations.
Through this approach, participants can clearly identify clinical scenarios where experts are in agreement on the best treatment options and other scenarios where the available supporting evidence does not clearly favor one treatment over another and, consequently, there is more diversity in expert choices.
The hope is to regularly update this online tool so that our recommendations evolve to include consideration of emerging data and newly available agents. We hope that you will try this tool and that you will find it useful in your care of adult patients with B-cell ALL.
What are your questions and suggestions regarding this online tool? Please answer the polling question and leave your comments in the discussion box below.
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