Indications and results of allogeneic stem cell transplantation in acute lymphoblastic leukemia and lymphoproliferative neoplasms

Haema 2016; 7(2): 230-241

by Panagiotis Kaloyannidis, Ioanna Sakellari

Department of Haematology and Bone Marrow Transplantation Unit, Papanikolaou General Hospital, Thessaloniki, Greece

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Abstract

The current induction therapy protocols for adult acute lymphoblastic leukemia have resulted in high remission rates but the optimal post remission therapy remains unclear. Allogeneic stem cell transplantation represents the most reliable antileukemic treatment. nowever, this option has been based on risk adapted approach and is recommended as treatment of choice for patients in 1st complete remission with high risk features and for any patient in more advanced disease phase as well. Recently, prospective trials have shown that early allogeneic stem cell transplantation may be the best treatment option, even for patients with standard risk characteristics. As only a minority of patients have a sibling donor, volunteer matched unrelated, haploidentical donors or umbilical cord blood could be alternate choices of allograft sources. Over the last years, the clinical research for acute lymphoblastic leukemia treatment and other hematological malignancies as well, has been focused on cellular therapies that represent a very attractive innovative approach by offering extremely low toxicity with promising effectiveness. The allogeneic haematopoietic cell transplantation in lymphoproliferative diseases is feasible due to the current use of non myeloablative – reduced intensity conditioning regimens for elderly or unfit patients. HCT is potentially curative in selected patients with a low tumor burden, a possibility that is further enhanced by the use of newer biological agents and innovative cellular therapies post HCT.