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Allogeneic hematopoietic cell transplantation for acute lymphoblastic leukemia in adults

Khaled, Samer K.; Thomas, Sandra H.; Forman, Stephen J.

doi: 10.1097/CCO.0b013e32834f5c41
TRANSPLANTATION: Edited by Richard J Jones

Purpose of review Acute lymphoblastic leukemia (ALL) is a heterogeneous disease, for which treatment guidelines are still evolving. Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative therapeutic modality for ALL, and this review describes the recent studies and current practice patterns concerning the who, when, and how of allo-HCT in the management of ALL.

Recent findings Allogeneic stem cell transplantation is the treatment of choice for patients with ALL after first relapse and is also recommended for high-risk patients in first complete remission (CR1). Minimal residual disease evaluation and monitoring is developing as an important prognostic factor and could guide physicians in determining which patients, especially those with standard risk, might require transplant. Tyrosine kinase inhibitor (TKI) therapy allows a much higher proportion of Philadelphia-chromosome-positive ALL patients to attain remission and proceed to transplant with improved results; posttransplant TKI maintenance therapy may also provide survival benefit. Reduced-intensity conditioning regimens are a reasonable alternative for patients who would otherwise be ineligible for transplant because of age or comorbidity.

Summary For patients with high-risk features, there is general agreement that allo-HCT in CR1 is a potentially curative option; however, there is no consensus on early transplant for standard-risk patients.

Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA

Correspondence to Stephen J. Forman, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA. Tel: +1 626 256 4673 ext. 62403; e-mail: sforman@coh.org

© 2012 Lippincott Williams & Wilkins, Inc.