Hematopoietic stem cell transplantation in the treatment of acute lymphoblastic leukemia in adults

Abstract

Hematopoietic stem cell transplantation is well recognized treatment option for adults withacute lymphoblastic leukemia (ALL). Allogeneic hematopoietic stem cell transplantation (allo--HSCT) from either human leukocyte antigen-identical sibling or human leukocyte antigen--matched unrelated donor should be considered for all patients with primary induction failureor relapse while in case of Philadelphia-positive ALL in first complete remission. In remainingcases the indications for allo-HSCT should be individualized taking into account the status ofminimal residual disease (MRD). Bone marrow is preferable source of stem cells for allo-HSCT. Conditioning regimen should be based on total body irradiation. Allo-HSCT withreduced intensity conditioning may be considered for elderly patients ineligible for myeloablativeregimens. The role of autologous hematopoietic stem cell transplantation requires verificationon further prospective trials. This procedure should be restricted to patients with the negativeMRD status.