What are the American Society for Blood and Marrow Transplantation (ASBMT) guidelines for stem cell transplantation (SCT) in acute lymphoblastic leukemia (ALL)?

Updated: Jul 17, 2018
  • Author: Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

In 2012, the American Society for Blood and Marrow Transplantation (ASBMT) updated its treatment recommendations for SCT in adults with ALL, based on new evidence. The updated recommendations include the following [87] :

  • Myeloblative allogeneic SCT is an appropriate treatment for adults younger than 35 years, in all risk groups during the first complete remission

  • Allogeneic SCT is recommended over chemotherapy for all adults with ALL during the second or subsequent complete remission

  • Allogeneic SCT is preferred over autologous SCT, with similar outcomes for related and unrelated allogeneic SCT

  • Imatinib therapy before and/or after SCT for Ph+ ALL results in higher survival rates

The 2016 ESMO guidelines include the following recommendations [86] :

  • Autologous SCT is not recommended outside of clinical trials
  • Allogeneic SCT is recommended after first complete remission in all patients with poor minimal residual disease, but not recommended for standard-risk patients with a sustained molecular response
  • After the second complete remission, allogeneic SCT was found superior to non-transplantation
  • Cord blood transplantation may be considered if no HLA-well-matched donor is found or the patient needs urgent SCT
  • Total body irradiation regimens are recommended for myeloablative SCT; reduced-intencity conditioning regimens should be used only in adults in remission unfit for myeloablative conditioning and elderly fit patients

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