Redefining transplant in acute leukemia.

Area of Science:

• Hematology
• Oncology
• Transplantation Medicine

Background:

• Acute leukemia treatment selection is complex, requiring thorough patient and disease assessment.
• Relapse risk stratification is advancing, incorporating cytogenetics, molecular data, and minimal residual disease (MRD) after treatment.
• Allogeneic hematopoietic progenitor cell transplantation (alloHCPT) is a highly effective therapeutic option.

Purpose of the Study:

• To provide guidance on the role of alloHCPT in managing adult acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).
• To discuss the evolving criteria for patient selection and transplant eligibility.
• To highlight the expanding role of unrelated donors and reduced-intensity conditioning (RIC) regimens.

Main Methods:

• Review of current clinical practices and emerging evidence in leukemia transplantation.
• Analysis of risk stratification factors including cytogenetics, molecular lesions, and MRD.
• Consideration of patient age, donor availability (matched sibling vs. unrelated donor), and conditioning regimens (myeloablative vs. RIC).

Main Results:

• For adult ALL, patients achieving complete remission (CR) with a matched sibling should be considered for alloHCPT.
• For AML, high-risk and most intermediate-risk patients in CR1 with a matched sibling should be offered alloHCPT; some good-risk patients may also benefit.
• Unrelated donor transplants and RIC regimens are expanding eligibility to older or less fit patients for both ALL and AML.

Conclusions:

• AlloHCPT is a critical treatment for acute leukemia, with expanding indications due to improved risk assessment and conditioning strategies.
• Patient selection for alloHCPT should consider disease risk, donor availability, and conditioning intensity.
• Enrollment in prospective clinical trials is crucial for advancing the field and optimizing patient outcomes.