Hematopoietic stem cell transplant in adults with acute lymphoblastic leukemia

the present state

Salwa S. Saadeh, Mark R Litzow

Research output: Contribution to journalReview article

Abstract

Introduction: Allogeneic hematopoietic stem cell transplant (allo-HSCT) has an important role in management of acute lymphoblastic leukemia (ALL). Proper patient selection is central to ensure optimal outcomes. Areas covered: This review covers various aspects of HSCT in ALL patients, including indications, donor selection, conditioning regimens, and post-transplant management. Expert commentary: Allo-HSCT is important in post-remission management of ALL but proper risk-stratification is a major challenge. Incorporation of minimal residual disease (MRD) and molecular testing will improve patient allocation. Patients receiving pediatric-inspired induction who achieve molecular remission might not need allo-HSCT in first remission. Allo-HSCT should be considered in patients who don’t achieve MDR negativity, didn’t receive intensive induction, or have high risk cytogenetic and molecular features. Despite improved responses with tyrosine kinase inhibitors (TKIs) in Philadelphia positive (Ph+) ALL, allo-HSCT remains standard. Matched sibling donors are the optimal graft source, but other sources are valid alternatives. There is no single optimal conditioning regimen and retrospective studies found myeloablative and reduced intensity regimens to be comparable. Following allo-HSCT, there is no role for maintenance therapy in Philadelphia-negative ALL. In Ph+ ALL, maintenance TKIs improve outcomes. The integration of targeted and immunotherapies in the peri-transplant period holds potential for improved outcomes.

Original languageEnglish (US)
Pages (from-to)195-207
Number of pages13
JournalExpert Review of Hematology
Volume11
Issue number3
DOIs
StatePublished - Mar 4 2018

Fingerprint

Hematopoietic Stem Cells
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Transplants
Protein-Tyrosine Kinases
Donor Selection
Residual Neoplasm
Cytogenetics
Immunotherapy
Patient Selection
Siblings
Retrospective Studies
Maintenance
Tissue Donors
Pediatrics

Keywords

  • Acute lymphoblastic leukemia
  • hematopoietic stem cell transplant
  • minimal residual disease
  • Philadelphia chromosome
  • Philadelphia-like ALL

ASJC Scopus subject areas

  • Hematology

Cite this

Hematopoietic stem cell transplant in adults with acute lymphoblastic leukemia : the present state. / Saadeh, Salwa S.; Litzow, Mark R.

In: Expert Review of Hematology, Vol. 11, No. 3, 04.03.2018, p. 195-207.

Research output: Contribution to journalReview article

@article{a975db5211de48c0a5efc2a75a74c6f9,
title = "Hematopoietic stem cell transplant in adults with acute lymphoblastic leukemia: the present state",
abstract = "Introduction: Allogeneic hematopoietic stem cell transplant (allo-HSCT) has an important role in management of acute lymphoblastic leukemia (ALL). Proper patient selection is central to ensure optimal outcomes. Areas covered: This review covers various aspects of HSCT in ALL patients, including indications, donor selection, conditioning regimens, and post-transplant management. Expert commentary: Allo-HSCT is important in post-remission management of ALL but proper risk-stratification is a major challenge. Incorporation of minimal residual disease (MRD) and molecular testing will improve patient allocation. Patients receiving pediatric-inspired induction who achieve molecular remission might not need allo-HSCT in first remission. Allo-HSCT should be considered in patients who don’t achieve MDR negativity, didn’t receive intensive induction, or have high risk cytogenetic and molecular features. Despite improved responses with tyrosine kinase inhibitors (TKIs) in Philadelphia positive (Ph+) ALL, allo-HSCT remains standard. Matched sibling donors are the optimal graft source, but other sources are valid alternatives. There is no single optimal conditioning regimen and retrospective studies found myeloablative and reduced intensity regimens to be comparable. Following allo-HSCT, there is no role for maintenance therapy in Philadelphia-negative ALL. In Ph+ ALL, maintenance TKIs improve outcomes. The integration of targeted and immunotherapies in the peri-transplant period holds potential for improved outcomes.",
keywords = "Acute lymphoblastic leukemia, hematopoietic stem cell transplant, minimal residual disease, Philadelphia chromosome, Philadelphia-like ALL",
author = "Saadeh, {Salwa S.} and Litzow, {Mark R}",
year = "2018",
month = "3",
day = "4",
doi = "10.1080/17474086.2018.1433030",
language = "English (US)",
volume = "11",
pages = "195--207",
journal = "Expert Review of Hematology",
issn = "1747-4086",
publisher = "Expert Reviews Ltd.",
number = "3",

}

TY - JOUR

T1 - Hematopoietic stem cell transplant in adults with acute lymphoblastic leukemia

T2 - the present state

AU - Saadeh, Salwa S.

AU - Litzow, Mark R

PY - 2018/3/4

Y1 - 2018/3/4

N2 - Introduction: Allogeneic hematopoietic stem cell transplant (allo-HSCT) has an important role in management of acute lymphoblastic leukemia (ALL). Proper patient selection is central to ensure optimal outcomes. Areas covered: This review covers various aspects of HSCT in ALL patients, including indications, donor selection, conditioning regimens, and post-transplant management. Expert commentary: Allo-HSCT is important in post-remission management of ALL but proper risk-stratification is a major challenge. Incorporation of minimal residual disease (MRD) and molecular testing will improve patient allocation. Patients receiving pediatric-inspired induction who achieve molecular remission might not need allo-HSCT in first remission. Allo-HSCT should be considered in patients who don’t achieve MDR negativity, didn’t receive intensive induction, or have high risk cytogenetic and molecular features. Despite improved responses with tyrosine kinase inhibitors (TKIs) in Philadelphia positive (Ph+) ALL, allo-HSCT remains standard. Matched sibling donors are the optimal graft source, but other sources are valid alternatives. There is no single optimal conditioning regimen and retrospective studies found myeloablative and reduced intensity regimens to be comparable. Following allo-HSCT, there is no role for maintenance therapy in Philadelphia-negative ALL. In Ph+ ALL, maintenance TKIs improve outcomes. The integration of targeted and immunotherapies in the peri-transplant period holds potential for improved outcomes.

AB - Introduction: Allogeneic hematopoietic stem cell transplant (allo-HSCT) has an important role in management of acute lymphoblastic leukemia (ALL). Proper patient selection is central to ensure optimal outcomes. Areas covered: This review covers various aspects of HSCT in ALL patients, including indications, donor selection, conditioning regimens, and post-transplant management. Expert commentary: Allo-HSCT is important in post-remission management of ALL but proper risk-stratification is a major challenge. Incorporation of minimal residual disease (MRD) and molecular testing will improve patient allocation. Patients receiving pediatric-inspired induction who achieve molecular remission might not need allo-HSCT in first remission. Allo-HSCT should be considered in patients who don’t achieve MDR negativity, didn’t receive intensive induction, or have high risk cytogenetic and molecular features. Despite improved responses with tyrosine kinase inhibitors (TKIs) in Philadelphia positive (Ph+) ALL, allo-HSCT remains standard. Matched sibling donors are the optimal graft source, but other sources are valid alternatives. There is no single optimal conditioning regimen and retrospective studies found myeloablative and reduced intensity regimens to be comparable. Following allo-HSCT, there is no role for maintenance therapy in Philadelphia-negative ALL. In Ph+ ALL, maintenance TKIs improve outcomes. The integration of targeted and immunotherapies in the peri-transplant period holds potential for improved outcomes.

KW - Acute lymphoblastic leukemia

KW - hematopoietic stem cell transplant

KW - minimal residual disease

KW - Philadelphia chromosome

KW - Philadelphia-like ALL

UR - http://www.scopus.com/inward/record.url?scp=85043514260&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85043514260&partnerID=8YFLogxK

U2 - 10.1080/17474086.2018.1433030

DO - 10.1080/17474086.2018.1433030

M3 - Review article

VL - 11

SP - 195

EP - 207

JO - Expert Review of Hematology

JF - Expert Review of Hematology

SN - 1747-4086

IS - 3

ER -