Debate: Transplant Is Still Necessary in the Era of Targeted Cellular Therapy for Acute Lymphoblastic Leukemia

Despite high complete remission (CR) rates, relapse remains a significant problem among subsets of patients with B acute lymphoblastic leukemia (ALL), and is associated with poor prognosis. The recent Food and Drug Administration approval of highly effective immunotherapies for B-lineage ALL (B-ALL), blinatumomab, inotuzumab ozogamicin, and tisagenlecleucel, a chimeric antigen receptor (CAR) modified T-cell therapy, targeting CD19, or CD22, have dramatically changed the therapeutic landscape for the treatment of B-ALL, resulting in high rates of deep and durable remissions. Therefore, there is now debate regarding the role of allogeneic hematopoietic cell transplantation (HCT) in this new landscape. Herein, we review these novel agents, and discuss the sequence of therapy, including allogeneic HCT in B-ALL.