title: Who Should Receive a Transplant for Acute Lymphoblastic Leukaemia?
abstract: Allogeneic haematopoietic cell transplantation continues to be an important curative therapy for acute lymphoblastic leukaemia (ALL). Traditionally accepted indications for allografting adult ALL patients need reevaluation in light of outcomes with paediatric-like intensive regimens. Minimal residual disease status and oncogenetics can be used for restratification of standard risk patients. A greater body of data on haematopoietic cell transplantation (HCT) outcomes from haploidentical and cord blood donor sources has been generated in recent years. In this review, we describe the indications for allografting adult ALL patients in first complete remission (CR1). Role of minimal residual disease (MRD) in optimising HCT for ALL is delineated. We also discuss how alternative donors, haploidentical and cord blood and reduced intensity conditioning make allografts more accessible to patients with high-risk ALL. Recent data on use of monoclonal antibodies and chimeric antigen receptor (CAR)-modified T cells in adult ALL patients are also reviewed.
authors.affiliation: Adult BMT Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8BJ, England, UK.
authors.forename: Rishi
authors.initials: R
authors.lastname: Dhawan
authors.affiliation: Adult BMT Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8BJ, England, UK. David.Marks@UHBristol.nhs.uk.
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
mesh_terms: D000066491:Clinical Decision-Making; D003131:Combined Modality Therapy; D019468:Disease Management; D019008:Drug Resistance, Neoplasm; D018380:Hematopoietic Stem Cell Transplantation; D006412:Hematopoietic Stem Cells / Q000166:cytology; D006801:Humans; D016219:Immunotherapy, Adoptive; D058990:Molecular Targeted Therapy; D018365:Neoplasm, Residual; D010677:Philadelphia Chromosome; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome
keywords: Acute lymphoblastic leukaemia; Allogeneic haematopoietic cell transplantation; Minimal residual disease; Monoclonal antibodies; Pre-transplant conditioning; Prognostic factors