title: High-risk pediatric acute lymphoblastic leukemia: to transplant or not to transplant?
abstract: Because survival with both chemotherapy and allogeneic hematopoietic stem cell transplantation (HSCT) approaches to high-risk pediatric acute lymphoblastic leukemia (ALL) generally improves through the years, regular comparisons of outcomes with either approach for a given indication are needed to decide when HSCT is indicated. Improvements in risk classification are allowing clinicians to identify patients at high risk for relapse early in their course of therapy. Whether patients defined as high risk by new methods will benefit from HSCT requires careful testing. Standardization and improvement of transplant approaches has led to equivalent survival outcomes with matched sibling and well-matched unrelated donors; however, survival using mismatched and haploidentical donors is generally worse. Trials comparing chemotherapy and HSCT must obtain sufficient data about therapy and stratify the analysis to assess the outcomes of best-chemotherapy with best-HSCT approaches.
authors.affiliation: Primary Children's Medical Center, Division of Hematology/Blood and Marrow Transplantation, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA. michael.pulsipher@hsc.utah.edu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pulsipher
authors.forename: Christina
authors.initials: C
authors.lastname: Peters
authors.forename: Ching-Hon
authors.initials: CH
authors.lastname: Pui
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D002648:Child; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000592:standards; D006801:Humans; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D012306:Risk
chemical_list: D000970:Antineoplastic Agents