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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.

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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. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation DeFilipp, Z., Advani, A. S., Bachanova, V., Cassaday, R. D., Deangelo, D. J., Kebriaei, P., Rowe, J. M., Seftel, M. D., Stock, W., Tallman, M. S., Fanning, S., Inamoto, Y., Kansagra, A., Johnston, L., Nagler, A., Sauter, C. S., Savani, B. N., Perales, M., Carpenter, P. A., Larson, R. A., Weisdorf, D. 2019

Abstract

The role of hematopoietic cell transplantation (HCT) for 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 upon 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. Studies to assess indications for transplant in the evolving landscape of MRD assessments and novel targeted and immune therapeutics remain important areas of investigation.

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