Pediatric acute lymphoblastic leukemia: is there still a role for transplant?

Constant questioning of the applicability of transplant for any diagnosis is appropriate. This is particularly necessary in fields such as pediatric leukemia, in which significant progress in therapy and risk classification is being made. Outcomes with chemotherapy are constantly improving, and donor availability and transplant outcomes are also better. It is important to be aware of likely outcomes when counseling families and recommending therapy, and to consider issues of likely late side effects. Biological studies that predict prognosis, for example, array-based studies, hold hope of identifying the children destined to relapse at the outset of disease. However, a rigorous approach must be taken in determining whether transplant does improve outcome whenever this strategy is applied.