Clinical research published since the first evidence-based review on the role of hematopoietic stem cell transplantation (SCT) in the treatment of acute lymphoblastic leukemia (ALL) in adults is presented and critically evaluated in this update. Treatment recommendations changed or modified based on new evidence include: (1) myeloablative allogeneic SCT is an appropriate treatment for adult (<35 years) ALL in first complete remission for all disease risk groups; and (2) reduced-intensity conditioning may produce similar outcomes to myeloablative regimens. Treatment recommendations unchanged or strengthened by new evidence include: (1) allogeneic SCT is recommended over chemotherapy for ALL in second complete remission or greater; (2) allogeneic is superior to autologous SCT; and (3) there are similar survival outcomes after related and unrelated allogeneic SCT. New treatment recommendations based on new evidence include: (1) in the absence of a suitable allogeneic donor, autologous SCT may be an appropriate therapy, but results in a high relapse rate; (2) it is appropriate to consider cord blood transplantation for patients with no HLA well-matched donor; and (3) imatinib therapy before and/or after SCT (for Ph+ ALL) yields significantly superior survival outcomes. Areas of needed research in the treatment of adult ALL with SCT were identified and presented in the review.
Bibliographical noteFunding Information:
Financial disclosure: Major funding for this review was provided by the National Marrow Donor Program. The authors have no financial conflicts of interest to disclose.
The American Society for Blood and Marrow Transplantation and Drs. Hahn and McCarthy are indebted to the members of the Adult ALL EBR Update Expert Panel and the ASBMT Evidence-Based Review Steering Committee, who voluntarily and enthusiastically participated in this endeavor. The authors of this Adult ALL EBR Update and the American Society for Blood and Marrow Transplantation thank the National Marrow Donor Program, and especially Jeffrey Chell, MD, and Michael Boo, for their support of this project. The authors acknowledge C. Fred LeMaistre, MD, for pioneering and supporting this effort and Thomas Joseph, MPS, CAE, for his invaluable administrative assistance. The authors are grateful to all the patients who participated in the clinical trials, which led to the evidence upon which this EBR update is based. Major funding for this study was provided by the National Marrow Donor Program.
- Acute lymphoblastic leukemia
- Evidence-based review
- Hematopoietic stem cell transplatation