Allogeneic stem cell transplantation for acute leukemia

Background: New, mainly targeted therapies are expanding treatment options for acute leukemias, especially for induction and salvage therapy. However, allogeneic stem cell transplantation (SCT) is a consolidation or salvage treatment for more than half of the patients diagnosed with acute leukaemia and advances are reported, especially in the areas of conditioning and immunomodulatory therapies for prevention and treatment of complications. These advances have led to significant improvement in treatment outcomes. Methods: Based on a literature search, indications for allogeneic SCT in acute myeloid (AML) and lymphoblastic (ALL) leukemia are summarized. Results: Classification of acute leukemia into biologically defined risk groups at the beginning of therapy and the degree of response to therapy including measurable residual disease are important indicators for allogeneic SCT. In ALL, molecular remission before SCT is crucial, and allogeneic SCT is a treatment option in patients with relapsed/refractory AML. Reduced intensity and remission-adapted conditioning, optimized donor identification strategies and new treatment options to control infectious and immunological complications have contributed to improved quality of life and prognosis for patients after allogeneic SCT. Conclusion: Successful treatment of acute leukemia is based on precise risk stratification at diagnosis, induction therapy adapted to the specific risk factors of the patient and the disease, and prudent selection of postremission or salvage therapy. Even in the era of antigen-specific cellular therapies, allogeneic SCT remains an important part of postinduction therapy concepts.