The Role of Transplants in Patients With ALL

Mark R. Litzow, MD, chair, ECOG-ACRIN Leukemia Committee, professor of medicine, Division of Hematology, Mayo Clinic, discusses the role of transplant in patients with acute lymphoblastic leukemia (ALL).

Clinical Pearls:

• The advent of pediatric-intensive chemotherapy regimens has demonstrated improved outcomes in younger patients compared to traditional chemotherapy regimens
• Benefit has also been seen in patients up to 40-45 years old, but patients older than 40-45 years did not tolerate the pediatric-intensive chemotherapy regimens as well due to complications and treatment-related mortality
• Due to these results, younger patients may not need transplants in first remission but younger patients with high-risk features, such as high white blood cell count or adverse cytogenetics, may still benefit from transplant
• Outcomes are worse in older patients who undergo chemotherapy treatment, but reduced-intensity conditioning transplant regimens are in development and have demonstrated encouraging results in older patients