Hematopoietic Stem Cell Transplantation for Adult Philadelphia-Negative Acute Lymphoblastic Leukemia in the First Complete Remission in the Era of Minimal Residual Disease
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Purpose of Review
The purpose of this review is to discuss the potential role of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for Philadelphia-negative (Ph−) adult acute lymphoblastic leukemia (ALL) in first complete remission (CR1) in the era of minimal residual disease (MRD).
Allo-HSCT continues to have a role in the therapy of a selected group of high-risk adult patients with ALL in CR1. Although the clinical significance of MRD has been studied less extensively in adults with ALL than in children, recent studies support its role as the strongest prognostic factor that can identify patients that are unlikely to be cured by standard chemotherapy and benefit from undergoing allo-HSCT. In addition, MRD status both pre- and post-HSCT has been found to correlate directly with the risk of relapse.
Currently, the clinical challenge consists on applying MRD and molecular failure to integrate novel agents and immunotherapy to lower MRD before allo-HSCT and to modulate the graft versus leukemia (GVL) effect after transplant.
KeywordsMinimal residual disease Hematopoietic stem cell transplantation Acute lymphoblastic leukemia Adult patients Philadelphia negative ALL Early consolidation MRD status Intensified therapy MRD techniques Graft versus leukemia Graft versus host disease
The authors would like to thank the Aramont Foundation for their support in the research activities of the Leukemia Clinic and Bone Marrow Transplant program at Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.
Compliance with Ethical Standards
Conflict of Interest
Christianne Bourlon, Dennis Lacayo-Leñero, Sergio Inclán-Alarcón, and Roberta Demichelis-Gómez declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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