Allogeneic stem cell transplantation in childhood ALL

Acute Lymphocytic Leukemia(ALL) is the most common cancer diagnosed in children and represents almost 25% of cancers in children younger than 15 years. Complete remission of disease is now typically achieved with pediatric chemotherapy regimens in approximately 95% of children with ALL, with up to 85% long-term survival rates. Interestingly, recent studies appears to show that young adults with ALL do better with pediatric regimens and specifically adult ones. Unfortunately, those who relapse after initial treatment have few good options and retreatment rarely produces a cure.

Three randomized controlled trials (RCTs) that compared outcomes of hematopoietic sibling stem cell transplantation(SCT) to outcomes with conventional-dose chemotherapy in children with ALL did not demonstrate superiority of transplantation in all comers but did suggest that those at high risk for relapse or those in relapse who were able to obtain another remission, did better. The literature in general shows promising results for allogeneic SCT in patients in first complete response at high risk for recurrence, and in patients in second or greater remission. This conclusion is further supported by an evidence-based systematic review of the literature sponsored by the American Society for Blood and Marrow Transplantation (ASBMT)(Hahn et al). Outcomes following matched unrelated donor and umbilical cord blood transplants have improved significantly over the past decade and may offer outcome similar to that obtained with matched sibling donor transplants.

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