Allogeneic transplantation in the treatment of acute leukemia

Background. Allogeneic hematopoietic stem cell transplantation (HSCT) is an evolutionary treatmentmodality for acute leukemia that has gained importance during the past decade. Methods. This article reviews the indications for HSCT. Results. For intermediate-risk acutemyeloid leukemia (AML) patients with a performance status allowing transplantation and an available HLA-identical familial or HLA-compatible unrelated donor, allogeneic HSCT is a standard post-remission treatment option; for high-risk patients, it is currently still the only therapeutic option with curative intent. Due to improvements in supportive therapy, establishment of reduced-intensity conditioning regimens, and increasing donor availability, allogeneic HSCT can also be considered in elderly AML patients with an otherwise poor prognosis. Allogeneic HSCT is currently the only curative treatment option in cases of refractory or relapsed leukemia. For high-or highest-risk acute lymphoblastic leukemia (ALL) patients, allogeneic HSCT should be recommended in the first complete remission. The indication for allogeneic HSCT for standard-risk ALL patients depends on the course of minimal residual disease. Conclusion. The decision to perform allogeneic HSCT depends mainly on the leukemia risk profile, donor availability, preexisting comorbidities, and last but not least, on the individual preferences of a well-informed patient.