Role of allogeneic hematopoietic cell transplantation in adults with acute lymphoblastic leukemia

Purpose of review Acute lymphoblastic leukemia (ALL) is a heterogeneous disease, and outcomes vary by patient age, immunophenotype, and clinical, cytogenetic and molecular features. The optimal postremission therapy for adults with ALL remains unclear, Recent findings Modern treatment strategies use a risk-adapted approach. The extension of 'pediatric-inspired' chemotherapy regimens into young and middle-age adults has improved their outcomes. Regimens that combine tyrosine kinase inhibitors with chemotherapy have improved the outcomes for patients with Philadelphia-chromosome-positive ALL. Improvements in transplantation technology with better donor matching and better supportive care have made this modality more widely available. Treatment-related morbidity and mortality are greater with hematopoietic cell transplantation (HCT) than with chemotherapy, although relapses are less common. Summary Available data indicate no clear consensus as to whether there is an advantage to allogeneic HCT over modern chemotherapy for adults with ALL with standard risk features while in the first complete remission (CR1). However, allogeneic HCT is recommended in CR1 for patients with 'high-risk' ALL and for those in a second complete remission.