Hematopoietic Stem Cell Transplantation in Pediatric Acute Lymphoblastic Leukemia

Abstract

The role of hematopoietic stem cell transplantation (HSCT) in pediatric acute lymphoblastic leukemia (ALL) is evolving. The indications for transplant in first complete remission (CR1) has decreased over the last decade; however, it continues to be an important salvage option in the treatment of persistent minimal residual disease-positive (MRD+) leukemias. Novel therapies including CAR-T cell therapy can provide a synergistic immune response along with allogeneic transplant in the management of relapsed leukemia. Haploidentical transplants have opened the doors to an expanded donor pool, and recent studies have shown non-inferior outcomes compared to other alternate donor transplants. The long-term morbidity including chronic graft-versus-host disease (cGvHD) needs to be addressed to improve the overall outcomes of transplant.