Biology of Blood and Marrow Transplantation
Volume 12, Issue 1 , Pages 1-30, January 2006

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

  • Theresa Hahn

      Affiliations

    • Roswell Park Cancer Institute, Buffalo, New York
    • Corresponding Author InformationCorrespondence and reprint requests: Theresa Hahn, PhD, Roswell Park Cancer Institute, Medicine, Elm and Carlton Sts, Buffalo, NY 14263.
    • ,
  • Donna Wall

      Affiliations

    • Texas Transplant Institute, San Antonio, Texas
    • ,
  • Bruce Camitta

      Affiliations

    • Midwest Children’s Center, Medical College of Wisconsin and Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
    • ,
  • Stella Davies

      Affiliations

    • Cincinnati Children’s Hospital and Medical Center, Cincinnati, Ohio
    • ,
  • Hildy Dillon

      Affiliations

    • The Leukemia and Lymphoma Society, White Plains, New York
    • ,
  • Paul Gaynon

      Affiliations

    • Children’s Hospital of Los Angeles, Los Angeles, California
    • ,
  • Richard A. Larson

      Affiliations

    • University of Chicago, Chicago, Illinois
    • ,
  • Susan Parsons

      Affiliations

    • Tufts-New England Medical Center, Boston, Massachusetts
    • ,
  • Jerome Seidenfeld

      Affiliations

    • Blue Cross and Blue Shield Association Technology Evaluation Center, Chicago, Illinois
    • ,
  • Daniel Weisdorf

      Affiliations

    • University of Minnesota, Minneapolis, Minnesota
    • ,
  • Philip L. McCarthy Jr

      Affiliations

    • Roswell Park Cancer Institute, Buffalo, New York

Received 18 October 2005; accepted 19 October 2005.

Abstract 

Evidence supporting the role of hematopoietic stem cell transplantation (SCT) in the therapy of acute lymphoblastic leukemia in adults (≥15 years) is presented and critically evaluated in this systematic evidence-based review. Specific criteria were used for searching the published medical 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 and were reached unanimously by a panel of acute lymphoblastic leukemia experts. The priority areas of needed future research for adult acute lymphoblastic leukemia are: definition of patients at high risk in first complete remission, beyond Philadelphia chromosome positive; outcomes of SCT in older (>50 years) adults; determination if reduced intensity versus myeloablative conditioning regimens yield an equivalent graft-versus-leukemia effect with reduced toxicity; monitoring of minimal residual disease to achieve disease control before SCT; and the use of cord blood and other alternative sources of stem cells for use in adult SCT recipients.

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

 

 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)00718-4

doi:10.1016/j.bbmt.2005.10.018

Biology of Blood and Marrow Transplantation
Volume 12, Issue 1 , Pages 1-30, January 2006

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