From the Onkologikum Frankfurt am Museumsufer and the Department of Hematology, Goethe-Universität Frankfurt, Frankfurt, Germany
Author's disclosures of potential conflicts of interest are found at the end of this article.
Address reprint requests to Dieter Hoelzer, MD, PhD, Onkologikum Frankfurt am Museumsufer, Schaubstr. 16, 60596 Frankfurt, Germany; e-mail: hoelzer{at}em.uni-frankfurt.de
Overview: In adult acute lymphoblastic leukemia (ALL), stem cell transplantation (SCT) is an essential and successful part of the treatment strategy. Whereas for all adult patients in a later stage of their disease in second or later complete remission, SCT is the first option — the major question in which the patient ("who") should have an immediate/primary SCT in first complete remission (CR) is controversially discussed and realized. This becomes evident if current SCT practice is analyzed according to the age of a patient with ALL. For children with ALL, the current attempt is to restrict SCT to high-risk or very high-risk patients because the cure rate with chemotherapy is up to approximately 90%. Thus, only 5% to 10% of children have a primary transplant. For adults (patients aged 18 to 55), there is a wide range of opinions: either to transplant according to prognostic factors,1,2 to transplant according to whether they are high-risk or very high-risk (e.g., Ph+ [Philadelphia chromosome] ALL) patients only, or to transplant all adult patients with ALL, including standard risk patients.3,4 For elderly patients with ALL (older than age 55), SCT is often recommended, but rarely realized. How to do we proceed from here? To what extent can published results contribute to such a decision?
