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Biol Blood Marrow Transplant. 2019 Nov;25(11):2113-2123. doi: 10.1016/j.bbmt.2019.08.014. Epub 2019 Aug 22.

Hematopoietic Cell Transplantation in the Treatment of Adult Acute Lymphoblastic Leukemia: Updated 2019 Evidence-Based Review from the American Society for Transplantation and Cellular Therapy.

Author information

1
Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA. Electronic address: zdefilipp@mgh.harvard.edu.
2
Department of Medical Oncology & Hematology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH.
3
Division of Hematology/Oncology/Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN.
4
Division of Clinical Research, Fred Hutchinson Cancer Research Center and Department of Medicine, University of Washington, Seattle, WA, USA.
5
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
6
Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX.
7
Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel.
8
CancerCare Manitoba, University of Manitoba, Winnipeg, Canada.
9
Department of Hematology and Oncology, Comprehensive Cancer Center, University of Chicago, Chicago, IL.
10
Leukemia Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY.
11
Hematology and Medical Oncology, Greenville Health System Cancer Institute, Greenville, SC.
12
Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
13
Department of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, TX.
14
Department of Medicine, Stanford University Medical Center, Stanford, CA.
15
Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel Hashomer, Israel.
16
Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY.
17
Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
18
Division of Clinical Research, Fred Hutchinson Cancer Research Center and Department of Pediatrics, University of Washington, Seattle, WA, USA.

Abstract

The role of hematopoietic cell transplantation (HCT) in adults with acute lymphoblastic leukemia (ALL) is reviewed and critically evaluated in this systematic evidence-based review. Specific criteria were used for searching the published literature and for grading the quality and strength of the evidence and the strength of the recommendations. A panel of ALL experts developed consensus on the treatment recommendations based on the evidence. Allogeneic HCT offers a survival benefit in selected patients with ALL, and this review summarizes the standard indications as well as the areas of controversy. There is now greater experience with pediatric-inspired chemotherapy regimens that has transformed upfront therapy for adult ALL, resulting in higher remission rates and overall survival. This in turn has increased the equipoise around decision making for ALL in first complete remission (CR1) when there is no measurable residual disease (MRD) at the end of induction and/or consolidation. Randomized studies are needed for adults with ALL to compare allogeneic HCT in CR1 with pediatric-inspired chemotherapy alone. Indications for transplantation in the evolving landscape of MRD assessments and novel targeted and immune therapeutics remain important areas of investigation.

KEYWORDS:

Acute lymphoblastic leukemia; Allogeneic hematopoietic cell transplantation; Autologous stem cell transplantation; Evidence-based review; Guideline

PMID:
31446198
DOI:
10.1016/j.bbmt.2019.08.014

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