Marcoux Curtis, Kebriaei Partow
Division of Hematology, Dalhousie University, Halifax, Canada.
Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX.
Hematology Am Soc Hematol Educ Program. 2024 Dec 6;2024(1):93-101. doi: 10.1182/hematology.2024000533.
Allogeneic hematopoietic stem cell transplantation (allo-HCT) remains a cornerstone in the treatment of high-risk acute lymphoblastic leukemia (ALL), yet optimal patient selection is challenging in the era of rapidly changing modern therapy. Refined molecular characterization allows for better risk assessment, sparing low-risk patients from allo-HCT toxicity while identifying those who may benefit from intensified approaches. Measurable residual disease (MRD) has emerged as a powerful predictor of relapse irrespective of treatment strategy, challenging the necessity of transplant in MRD-negative patients. Further, expanded donor options, particularly haploidentical transplantation coupled with reduced intensity conditioning, have extended the applicability of allo-HCT to a broader range of patients. Finally, immunotherapies and targeted treatments are increasingly integrated into both initial and relapsed treatment protocols yielding deep remission and allowing for successful transplant in patients with a history of advanced disease. In this review, we provide an overview of the contemporary role of transplant in adult patients with ALL, focusing on indications for allo-HCT in first remission, optimal sequencing of transplant with novel therapies, and advancements in donor selection and conditioning regimens.
异基因造血干细胞移植（allo-HCT）仍然是高危急性淋巴细胞白血病（ALL）治疗的基石，然而在现代治疗迅速发展的时代，最佳的患者选择具有挑战性。精细的分子特征分析有助于更好地进行风险评估，使低风险患者免受allo-HCT毒性影响，同时识别那些可能从强化治疗方法中获益的患者。无论治疗策略如何，可测量残留病（MRD）已成为复发的有力预测指标，这对MRD阴性患者进行移植的必要性提出了挑战。此外，扩大的供体选择，特别是单倍体相合移植与减低强度预处理相结合，已将allo-HCT的适用性扩展到更广泛的患者群体。最后，免疫疗法和靶向治疗越来越多地整合到初始治疗和复发治疗方案中，实现深度缓解，并使有晚期疾病史的患者能够成功进行移植。在本综述中，我们概述了移植在成年ALL患者中的当代作用，重点关注首次缓解期allo-HCT的适应症、移植与新疗法的最佳序贯安排，以及供体选择和预处理方案的进展。
