Transplant in ALL: who, when, and how?

Area of Science:

• Hematology
• Oncology
• Transplantation Medicine

Background:

• Allogeneic hematopoietic stem cell transplantation (allo-HCT) is a critical treatment for high-risk acute lymphoblastic leukemia (ALL).
• Optimal patient selection for allo-HCT is complex due to evolving therapeutic strategies.
• Refined risk stratification is essential to balance transplant benefits against toxicity.

Purpose of the Study:

• To review the current role of allo-HCT in adult ALL treatment.
• To discuss indications for allo-HCT in first remission.
• To explore the integration of novel therapies and advancements in donor selection and conditioning.

Main Methods:

• Review of contemporary literature on allo-HCT for adult ALL.
• Analysis of the impact of molecular characterization and measurable residual disease (MRD) on transplant decisions.
• Evaluation of expanded donor options and novel immunotherapies/targeted treatments.

Main Results:

• Measurable residual disease (MRD) is a strong predictor of relapse, influencing transplant necessity in MRD-negative patients.
• Haploidentical transplantation and reduced intensity conditioning broaden allo-HCT applicability.
• Integration of immunotherapies and targeted agents facilitates successful transplant in advanced disease.

Conclusions:

• Contemporary allo-HCT strategies for adult ALL require careful patient selection based on molecular risk and MRD status.
• Advancements in donor options and conditioning regimens enhance transplant outcomes.
• The optimal sequencing of transplant with novel therapies is crucial for maximizing efficacy in ALL treatment.