Indications for Transplantation of ALL from a Pediatric Perspective

Abstract

 While the long-term survival rate for childhood acute lymphoblastic leukemia (ALL) has improved to approximately 90%, late complications associated with transplantation are more important in children, and the indication for transplantation is carefully selected. Stratified therapy has been adopted for ALL, and only “very-high risk” patients are transplanted in the first remission. Hematopoietic cell transplantation in first remission has been considered for infantile ALL (with KMT2A rearrangement), BCR-ABL1-positive ALL, and hypodiploid ALL, but with improved outcomes for each group and advances in minimal residual disease (MRD) assays, it is now limited to a few groups, including those with residual MRD. Indication of transplantation in recurrent ALL is also changing based on the risk of recurrence based on the timing and site of recurrence. The indication for transplantation in pediatric ALL should be carefully discussed based on existing evidence and according to the situation of each patient. Optimization of the role of transplantation in the overall treatment strategy for ALL based on a shared discussion between pediatric and adult patients is expected.