Professional Statements and Societal Positions Guidelines
National Comprehensive Cancer Network – 2019
Current National Comprehensive Cancer Network guidelines (v.2.2019) for ALL indicate allo-HCT is appropriate for consolidation treatment of most poor risk (e.g., the Philadelphia chromosome-positive, relapsed, or refractory) patients with ALL. The guidelines state that for appropriately fit older adults with ALL who are achieving remission, “consideration of autologous or reduced-intensity allogeneic stem cell transplantation may be appropriate.” In addition, the guidelines note that chronologic age is not a good surrogate for fitness for therapy and that patient should be evaluated on an individual basis.
Current National Comprehensive Cancer Network guidelines (v.2.2020) for pediatric ALL say that "Allogeneic HSCT has demonstrated improved clinical outcomes in pediatric ALL patients with evidence of certain high-risk features and/or persistent disease. In addition, survival rates appear to be comparable regardless of the stem cell source (matched related, matched unrelated, cord blood, or haploidentical donor)."
American Society for Blood and Marrow Transplantation – 2015
The guidelines from the American Society for Blood and Marrow Transplantation (2015)were publishedon indications for autologous and allogeneic HCT. Recommendations were intended to describe the current consensus on theuseof HCT in and out of the clinical trial setting.Recommendations on ALLare listedin the below table.
Guidelines for Autologous and Allogeneic HCT in ALL
Indication
|
Children (Age <18 Years)
|
Adults (Age ≥18 Years)
|
| |
Allogeneic HCT
|
Autologous HCT
|
Allogeneic HCT
|
Autologous HCT
|
First complete response, standard-risk
|
N
|
N
|
S
|
C
|
First complete response, high-risk
|
S
|
N
|
S
|
N
|
Second complete response
|
S
|
N
|
S
|
C
|
At least third complete response
|
C
|
N
|
C
|
N
|
Not in remission
|
C
|
N
|
C
|
N
|
ALL: acute lymphoblastic leukemia; C: clinical evidence available; HCT: hematopoietic cell transplantation; N: notgenerallyrecommended; S: standard of care.