Criteria for and outcomes of allogeneic haematopoietic stem cell transplant in children, adolescents and young adults with acute lymphoblastic leukaemia in first complete remission

Authors

  • Jessica Hochberg,

    1. Department of Pediatrics, New York Medical College, Valhalla, NY, USA
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  • Samer Khaled,

    1. Department of Hematology and Hematopoietic Stem Cell Transplantation, City of Hope, Duarte, CA, USA
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  • Stephen J. Forman,

    1. Department of Hematology and Hematopoietic Stem Cell Transplantation, City of Hope, Duarte, CA, USA
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  • Mitchell S. Cairo

    Corresponding author
    1. Department of Medicine, New York Medical College, Valhalla, NY, USA
    2. Department of Pathology, New York Medical College, Valhalla, NY, USA
    3. Department of Microbiology and Immunology, New York Medical College, Valhalla, NY, USA
    4. Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY, USA
    • Department of Pediatrics, New York Medical College, Valhalla, NY, USA
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Correspondence: Mitchell S. Cairo, Pediatric Hematology, Oncology and Stem Cell Transplantation, Children and Adolescent Cancer and Blood Diseases Center, Cellular and Tissue Engineering Laboratory, Department of Pediatrics, Pediatrics, Medicine, Pathology, Microbiology & Immunology and Cell Biology & Anatomy, New York Medical College, Munger Pavilion, Room 110, Valhalla, NY 10595, USA.

E-mail: mitchell_cairo@nymc.edu

Summary

Most children, adolescents and young adults with acute lymphoblastic leukaemia (ALL) in first complete remission (CR1) have an excellent prognosis with multi-agent chemotherapy in induction, consolidation, re-induction and maintenance therapy. However, there is a subset of patients with a more guarded prognosis using this approach, who may benefit from haematopoietic allogeneic stem cell transplantation (alloHSCT). Commonly used criteria for alloHSCT in children, adolescents and young adults with ALL in CR1 include: induction failure, poor cytogenetics, persistent minimal residual disease (MRD), age, immunophenotype, white blood cell count at diagnosis and rapidity of induction response. Two-year event-free survival following alloHSCT in patients with ALL in CR1 ranges from 50 to 80% depending on disease status, donor source, conditioning therapy, age and other risk factors. Future studies should focus on more precisely identifying poor-risk features, such as disease genomics and host pharmacogenomics, refining MRD measurements, improving unrelated donor matching, reducing MRD prior to alloHSCT, and developing post-alloHSCT humoral and cellular therapy approaches.

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