The Role of Cytotoxic Therapy with Hematopoietic Stem Cell Transplantation in the Therapy of Acute Lymphoblastic Leukemia in Children: An Evidence-Based Review

Received 10 August 2005; accepted 10 August 2005.

Abstract

Evidence supporting the role of hematopoietic stem cell transplantation (SCT) in the therapy of acute lymphoblastic leukemia (ALL) in children is presented and critically evaluated in this systematic evidence-based review. Specific criteria were used for searching the published literature and for grading the quality and strength of the evidence and the strength of the treatment recommendations. Treatment recommendations based on the evidence are presented in a table in this review (Summary of Treatment Recommendations Made by the Expert Panel for Pediatric Acute Lymphoblastic Leukemia) and were reached unanimously by a panel of ALL experts. The priority areas of needed future research in pediatric ALL are unrelated marrow or blood donor versus unrelated cord blood donor allogeneic SCT; alternative, nonfamily allogeneic donor versus autologous SCT; better methods for identifying high-relapse-risk patients; assessments of the effect of current chemotherapy regimens on early relapse; and use of pre-SCT detection of minimal residual disease to predict post-SCT outcomes.

Key words: Acute lymphoblastic leukemia , Hematopoietic stem cell transplantation , Therapy , Pediatric

1 Roswell Park Cancer Institute, Buffalo, New York

2 Texas Transplant Institute, San Antonio, Texas

3 Midwest Children’s Center, Medical College of Wisconsin and Children’s Hospital of Wisconsin, Milwaukee, Wisconsin

4 Cincinnati Children’s Hospital and Medical Center, Cincinnati, Ohio

5 The Leukemia and Lymphoma Society, White Plains, New York

6 Children’s Hospital of Los Angeles, Los Angeles, California

7 University of Chicago, Chicago, Illinois

8 Dana-Farber Cancer Institute/Harvard Medical School and Tufts New England Medical Center/Tufts University, Boston, Massachusetts

9 Blue Cross and Blue Shield Association Technology Evaluation Center, Chicago, Illinois

10 University of Minnesota, Minneapolis, Minnesota

Correspondence and reprint requests: Theresa Hahn, PhD, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263

All terms abbreviated in this article are defined in a Glossary of Terms, Appendix A, at the end of the article.

PII: S1083-8791(05)00567-7

doi:10.1016/j.bbmt.2005.08.035

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