Acute lymphocytic leukemia: role of hematopoietic stem cell transplantation in current management

Purpose of review It is still unclear what the best postremission therapy is for young adults with acute lymphocytic leukemia (ALL). Encouraging results, supporting the superiority of allogeneic stem cell transplantation in CR1 compared with chemotherapy/allogeneic stem cell transplantation (ASCT), are coming from the ongoing international prospective MRC UKALL XII/ECOG 2993 study. However, the transplant-related morbidity and mortality remain high. Recent findings The detection of persistent minimal residual disease (MRD) after induction and consolidation therapy is being increasingly used to identify high-risk patients for whom allogeneic transplant may offer the only curative option. Summary The ultimate aim is to determine whether the absence of MRD pretransplant can be used as a surrogate for low-risk adult ALL that can be cured without allogeneic transplantation.