While adult patients with acute lymphoblastic leukemia (ALL) can now achieve complete remission (CR) rates of up to 90% with intensive chemotherapy regimens, only 25-50% of these patients remain in long-term remission. Current research efforts are focused on innovative post-remission strategies with the goal of improving disease-free (DFS) and overall survival (OS). The identification of different prognostic groups based on the biology of the malignant clone and clinical patterns of disease presentation allows for risk-adapted therapy. Multiple randomized trials have demonstrated that hematopoietic stem cell transplantation (SCT) improves the outcome of patients with high-risk ALL. Among high-risk patients, the presence of disease at time of stem cell transplantation, and the source of stem cells used have great impact on survival. The incorporation of monoclonal antibodies into the transplant preparative regimen may improve transplant efficacy. The use of donor lymphocyte infusions (DLI) is still under investigation in this patient population.
Acute lymphoblastic leukemia; allogeneic stem cell transplantation; prognostic factors
