What is the role of stem cell transplantation in the treatment of acute lymphoblastic leukemia (ALL)?

Updated: Jul 02, 2021
  • Author: Karen Seiter, MD; Chief Editor: Matthew C Foster, MD  more...
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Stem cell transplantation represents the most intensive postremission therapy and potentially increases a patient's chance for cure. Although autologous stem cell transplantation has lower treatment-related mortality than allogeneic transplantation, the relapse rate is higher than for patients receiving allogeneic stem cell transplantation.  [3, 24, 25, 26] However, patients undergoing allogeneic stem cell transplantation frequently develop complications from graft versus host disease that can affect long-term survival as well as quality of life.

The GOELAL02 trial evaluated the impact of early allogeneic bone marrow transplantation or delayed unpurged autologous stem cell transplantation for patients with ALL who had no human leukocyte antigen (HLA)–matched sibling donor or who were older than 50 y. [24]  Inclusion criteria included at least one of the following: age older than 35 y; non–T-ALL; leukocytosis > 30,000/mm3; t(9;22), t(4;11), or t(1;19); or failure to achieve complete remission after one induction course; among 198 patients, the median age was 33 y.  For patients younger than 50 y, allogeneic bone marrow transplantation significantly improved the 6 y OS (75% vs 40% after autologous stem cell transplantation).

The LALA trial analyzed the benefits of a risk-adapted postremission strategy in adult lymphoblastic leukemia and evaluated stem cell transplantation for high-risk patients. [3]  Patients in the higher-risk group who had a sibling donor underwent allogeneic transplantation; the remaining patients received either an autologous stem cell transplant or postremission chemotherapy. Overall, allogeneic stem cell transplantation improved disease-free survival; however, autologous stem cell transplantation did not confer a significant benefit over chemotherapy.

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