Acute lymphoblastic leukaemia: whom and when should we transplant?

To date, the evidence upon which a decision is made to transplant a child with acute lymphoblastic leukaemia either in first or subsequent remission has rarely been based on randomized trial data. Modern era management of infection and graft-versus-host disease lessens risks but procedure-related deaths still remain higher than with chemotherapy alone. However, disease control appears superior with successful bone marrow transplantation (BMT). The critical need is for international consensus on who is at such great risk of recurrent disease that BMT is required (from no matter what donor source) and conversely those for whom transplantation is not needed to achieve long-term cure.