Hematopoietic stem cell transplantation for adults with acute lymphoblastic leukemia

The long-term survival for patients with adult acute lymphoblastic leukemia (ALL) has not significantly changed over the past two decades and, as opposed to pediatric ALL, it is less than 40% despite high initial complete remission rate. These observations raise several important issues regarding the pathobiology of adult leukemic stem cells, the ability of adults to tolerate intensive treatment and the best postremission approach.

Progress has been made in understanding the biology of adult ALL and its prognostic significance. The follow-up of minimal residual disease status, adopting protocols from childhood ALL to young adults and use of targeted therapy may improve long-term survival. Transplantation for standard-risk ALL in first remission proved to be beneficial in a large cooperative group study. Limited data on the use of alternative donor transplantation as well as reduced intensity protocols are now available for consideration in specific groups of patients.

Data suggest that the best antileukemic treatment should be applied in first remission and type of treatment should be based on individualized risk stratification, while incorporating recent information on alternative donors and reduced intensity approaches to transplantation.