Recommendations regarding decision to proceed to a sibling-matched related donor (MRD) or matched-unrelated donor (MUD) allogeneic hematopoietic stem cell transplant (HSCT) as therapy for acute lymphoblastic leukemia (ALL) patients < age 55 years.
| Disease indication . | MRD transplant recommended? . | MUD transplant recommended? . | Comments . |
|---|---|---|---|
| *High-risk cytogenetics defined as: t(4:11), t(8:14), complex karyotype (≥ 5 abnormalities), hypodiploidy/near triploidy | |||
| Abbreviations: CR1, first complete remission; CR2, second complete remission; TRM, treatment-related mortality; GVL, graft-versus-leukemia; Ph, Philadelphia chromosome | |||
| CR1 patients < 40 y: | Yes | No | |
| Standard-risk | |||
| CR1 patients < 40 y: | Yes | Yes | For high-risk cytogenetics,* increased relapse risk with standard chemotherapy. Unknown if allogeneic HSCT decreases risk. |
| High-risk | |||
| CR1 patients ≥ 40 y | Possibly, using reduced- intensity conditioning | No | Allogeneic transplantation decreases relapse risk, but TRM offsets benefit; reduced-intensity conditioning regimens being explored. |
| ≥ CR2 | Yes | Yes | |
| Primary refractory disease | Yes | Yes | |
| Ph+ disease | Yes | Yes | Highly potent allogeneic GVL effect in Ph+ disease |
| Minimal residual disease positivity after induction in Ph– disease patients | Yes | Possibly | Patients with minimal residual disease have increased relapse risk with standard therapy alone. |
| Only Ph+ disease shown to benefit from allogeneic HSCT. | |||
| Insufficient data on impact of HSCT in others. | |||
| Disease indication . | MRD transplant recommended? . | MUD transplant recommended? . | Comments . |
|---|---|---|---|
| *High-risk cytogenetics defined as: t(4:11), t(8:14), complex karyotype (≥ 5 abnormalities), hypodiploidy/near triploidy | |||
| Abbreviations: CR1, first complete remission; CR2, second complete remission; TRM, treatment-related mortality; GVL, graft-versus-leukemia; Ph, Philadelphia chromosome | |||
| CR1 patients < 40 y: | Yes | No | |
| Standard-risk | |||
| CR1 patients < 40 y: | Yes | Yes | For high-risk cytogenetics,* increased relapse risk with standard chemotherapy. Unknown if allogeneic HSCT decreases risk. |
| High-risk | |||
| CR1 patients ≥ 40 y | Possibly, using reduced- intensity conditioning | No | Allogeneic transplantation decreases relapse risk, but TRM offsets benefit; reduced-intensity conditioning regimens being explored. |
| ≥ CR2 | Yes | Yes | |
| Primary refractory disease | Yes | Yes | |
| Ph+ disease | Yes | Yes | Highly potent allogeneic GVL effect in Ph+ disease |
| Minimal residual disease positivity after induction in Ph– disease patients | Yes | Possibly | Patients with minimal residual disease have increased relapse risk with standard therapy alone. |
| Only Ph+ disease shown to benefit from allogeneic HSCT. | |||
| Insufficient data on impact of HSCT in others. | |||