Stem Cell Transplantation in the Treatment of Acute Lymphoblastic Leukemia: Recommendations

Guideline Objective

1. To establish the indications for allogeneic stem cell transplantation (allo-SCT) in the management of acute lymphoblastic leukemia (ALL) in adults
2. To identify the role of reduced-intensity conditioning (RIC) regimens for SCT in the management of ALL of adult patients
3. To identify the role of tyrosine-kinase inhibitors (TKIs) for patients undergoing allo-SCT for Philadelphia chromosome-positive ALL (Ph+ ALL)
4. To identify the role of alternative donor transplantation (haploidentical, cord blood) in the management of adult patients with ALL who lack a suitable related or unrelated donor.

Patient Population

Adult ALL patients considered for treatment that involves SCT.

Intended Guideline Users

Physicians performing SCT in Ontario, healthcare institutions and system leaders responsible for providing resources for SCT.

Research Question(s)

1. Does allo-SCT improve the outcome of adult patients with ALL in CR1 or beyond when compared with conventional chemotherapy (CT)?
2. Does a RIC or non-myeloablative conditioning allo-SCT improve the outcome of adult patients with ALL who are not suitable for ablative regimens when compared with standard non-transplant therapies?
3. Does the use of BCR-ABL TKIs following allogeneic transplantation improve the outcome of adult patients with Philadelphia chromosome-positive ALL when compared with allogeneic transplantation without TKI?
4. Does alternative donor transplant (haploidentical, cord blood) improve the outcome of adult patients with ALL who lack a suitable related or unrelated donor compared with standard, non-transplant chemotherapy?