Allogeneic stem cell transplantation for adult acute lymphoblastic leukemia: when and how.

A llogeneic hematopoietic stem cell transplantation (HSCT) with a myeloablative conditioning regi-men is considered the most potent post-remission antileukemic therapy in adult acute lymphoblastic leukemia (ALL). 1,2 However, an adequate balance should be established between its curative potential, the disadvantages (transplant-related mortality, late complications and reduced quality of life) and the improved outcome of the current chemotherapy regimens. 3-7 Large prospective trials, 8 several meta-analyses of randomized trials 9,10 and modeling studies 11 have concluded that allogeneic HSCT with myeloablative conditioning is of benefit for high-risk adult patients in first complete remission. The benefit of HSCT in patients with standard-risk features is controversial. Although the largest randomized trial in adult ALL so far showed a significant advantage of HSCT in patients with standard-risk-ALL, 8 the results of the current pedi-atric-inspired protocols are better than those from the