Which patients should I transplant with acute lymphoblastic leukemia?

Best Pract Res Clin Haematol. 2017 Sep;30(3):249-260. doi: 10.1016/j.beha.2017.07.005. Epub 2017 Jul 13.

Abstract

Allogeneic hematopoietic cell transplantation for acute lymphoblastic leukemia (ALL) offers curative therapy for patients who are in complete remission. Historically, there was great hesitation to offer this modality to patients with ALL due to the high attendant morbidity and mortality. Furthermore, the outstanding results in childhood ALL led many to believe that significant long-term survival could be achieved using chemotherapy-based regimens alone. The International ALL Study jointly conducted by ECOG and MRC completely changed perceptions indicating, surprisingly to many, that transplantation - particularly for patients at standard risk - offered a significant survival advantage. There followed trials of more intensive chemotherapy demonstrating improved results that may obviate the need for allogeneic transplantation. While a certain controversy reigns, there are unequivocal high-risk scenarios where allogeneic transplantation still forms the core of curative therapy. Such transplants should be performed as early as possible in the course of the disease once remission has been obtained.

Keywords: Acute lymphoblastic leukemia; Early T cell; High-risk; MRD positivity; Older patients; Ph-like; Ph-positive; Transplant.

Publication types

  • Review

MeSH terms

  • Antibodies, Bispecific / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Clinical Trials as Topic
  • Combined Modality Therapy / methods*
  • Graft vs Leukemia Effect*
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Philadelphia Chromosome
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / immunology
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / mortality
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / pathology
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / therapy*
  • Protein Kinase Inhibitors / therapeutic use
  • Remission Induction
  • Risk Factors
  • Survival Analysis
  • Transplantation, Homologous

Substances

  • Antibodies, Bispecific
  • Protein Kinase Inhibitors
  • blinatumomab