Cargando…

Allogeneic Hematopoietic Stem Cell Transplantation for Children With Acute Lymphoblastic Leukemia: Shifting Indications in the Era of Immunotherapy

Pediatric acute lymphoblastic leukemia generally carries a good prognosis, and most children will be cured and become long-term survivors. However, a portion of children will harbor high-risk features at the time of diagnosis, have a poor response to upfront therapy, or suffer relapse necessitating...

Descripción completa

Detalles Bibliográficos
Autores principales: Truong, Tony H., Jinca, Cristian, Mann, Georg, Arghirescu, Smaranda, Buechner, Jochen, Merli, Pietro, Whitlock, James A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8733383/
https://www.ncbi.nlm.nih.gov/pubmed/35004545
http://dx.doi.org/10.3389/fped.2021.782785
_version_ 1784627793100800000
author Truong, Tony H.
Jinca, Cristian
Mann, Georg
Arghirescu, Smaranda
Buechner, Jochen
Merli, Pietro
Whitlock, James A.
author_facet Truong, Tony H.
Jinca, Cristian
Mann, Georg
Arghirescu, Smaranda
Buechner, Jochen
Merli, Pietro
Whitlock, James A.
author_sort Truong, Tony H.
collection PubMed
description Pediatric acute lymphoblastic leukemia generally carries a good prognosis, and most children will be cured and become long-term survivors. However, a portion of children will harbor high-risk features at the time of diagnosis, have a poor response to upfront therapy, or suffer relapse necessitating more intensive therapy, which may include allogeneic hematopoietic stem cell transplant (HSCT). Recent advances in risk stratification, improved detection and incorporation of minimal residual disease (MRD), and intensification of upfront treatment have changed the indications for HSCT over time. For children in first complete remission, HSCT is generally reserved for those with the highest risk of relapse. These include patients with unfavorable features/cytogenetics who also have a poor response to induction and consolidation chemotherapy, usually reflected by residual blasts after prednisone or by detectable MRD at pre-defined time points. In the relapsed setting, children with first relapse of B-cell ALL are further stratified for HSCT depending on the time and site of relapse, while all patients with T-cell ALL are generally consolidated with HSCT. Alternatives to HSCT have also emerged over the last decade including immunotherapy and chimeric antigen receptor (CAR) T-cell therapy. These novel agents may spare toxicity while attempting to achieve MRD-negative remission in the most refractory cases and serve as a bridge to HSCT. In some situations, these emerging therapies can indeed be curative for some children with relapsed or resistant disease, thus, obviating the need for HSCT. In this review, we seek to summarize the role of HSCT in the current era of immunotherapy.
format Online
Article
Text
id pubmed-8733383
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-87333832022-01-07 Allogeneic Hematopoietic Stem Cell Transplantation for Children With Acute Lymphoblastic Leukemia: Shifting Indications in the Era of Immunotherapy Truong, Tony H. Jinca, Cristian Mann, Georg Arghirescu, Smaranda Buechner, Jochen Merli, Pietro Whitlock, James A. Front Pediatr Pediatrics Pediatric acute lymphoblastic leukemia generally carries a good prognosis, and most children will be cured and become long-term survivors. However, a portion of children will harbor high-risk features at the time of diagnosis, have a poor response to upfront therapy, or suffer relapse necessitating more intensive therapy, which may include allogeneic hematopoietic stem cell transplant (HSCT). Recent advances in risk stratification, improved detection and incorporation of minimal residual disease (MRD), and intensification of upfront treatment have changed the indications for HSCT over time. For children in first complete remission, HSCT is generally reserved for those with the highest risk of relapse. These include patients with unfavorable features/cytogenetics who also have a poor response to induction and consolidation chemotherapy, usually reflected by residual blasts after prednisone or by detectable MRD at pre-defined time points. In the relapsed setting, children with first relapse of B-cell ALL are further stratified for HSCT depending on the time and site of relapse, while all patients with T-cell ALL are generally consolidated with HSCT. Alternatives to HSCT have also emerged over the last decade including immunotherapy and chimeric antigen receptor (CAR) T-cell therapy. These novel agents may spare toxicity while attempting to achieve MRD-negative remission in the most refractory cases and serve as a bridge to HSCT. In some situations, these emerging therapies can indeed be curative for some children with relapsed or resistant disease, thus, obviating the need for HSCT. In this review, we seek to summarize the role of HSCT in the current era of immunotherapy. Frontiers Media S.A. 2021-12-23 /pmc/articles/PMC8733383/ /pubmed/35004545 http://dx.doi.org/10.3389/fped.2021.782785 Text en Copyright © 2021 Truong, Jinca, Mann, Arghirescu, Buechner, Merli and Whitlock. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Truong, Tony H.
Jinca, Cristian
Mann, Georg
Arghirescu, Smaranda
Buechner, Jochen
Merli, Pietro
Whitlock, James A.
Allogeneic Hematopoietic Stem Cell Transplantation for Children With Acute Lymphoblastic Leukemia: Shifting Indications in the Era of Immunotherapy
title Allogeneic Hematopoietic Stem Cell Transplantation for Children With Acute Lymphoblastic Leukemia: Shifting Indications in the Era of Immunotherapy
title_full Allogeneic Hematopoietic Stem Cell Transplantation for Children With Acute Lymphoblastic Leukemia: Shifting Indications in the Era of Immunotherapy
title_fullStr Allogeneic Hematopoietic Stem Cell Transplantation for Children With Acute Lymphoblastic Leukemia: Shifting Indications in the Era of Immunotherapy
title_full_unstemmed Allogeneic Hematopoietic Stem Cell Transplantation for Children With Acute Lymphoblastic Leukemia: Shifting Indications in the Era of Immunotherapy
title_short Allogeneic Hematopoietic Stem Cell Transplantation for Children With Acute Lymphoblastic Leukemia: Shifting Indications in the Era of Immunotherapy
title_sort allogeneic hematopoietic stem cell transplantation for children with acute lymphoblastic leukemia: shifting indications in the era of immunotherapy
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8733383/
https://www.ncbi.nlm.nih.gov/pubmed/35004545
http://dx.doi.org/10.3389/fped.2021.782785
work_keys_str_mv AT truongtonyh allogeneichematopoieticstemcelltransplantationforchildrenwithacutelymphoblasticleukemiashiftingindicationsintheeraofimmunotherapy
AT jincacristian allogeneichematopoieticstemcelltransplantationforchildrenwithacutelymphoblasticleukemiashiftingindicationsintheeraofimmunotherapy
AT manngeorg allogeneichematopoieticstemcelltransplantationforchildrenwithacutelymphoblasticleukemiashiftingindicationsintheeraofimmunotherapy
AT arghirescusmaranda allogeneichematopoieticstemcelltransplantationforchildrenwithacutelymphoblasticleukemiashiftingindicationsintheeraofimmunotherapy
AT buechnerjochen allogeneichematopoieticstemcelltransplantationforchildrenwithacutelymphoblasticleukemiashiftingindicationsintheeraofimmunotherapy
AT merlipietro allogeneichematopoieticstemcelltransplantationforchildrenwithacutelymphoblasticleukemiashiftingindicationsintheeraofimmunotherapy
AT whitlockjamesa allogeneichematopoieticstemcelltransplantationforchildrenwithacutelymphoblasticleukemiashiftingindicationsintheeraofimmunotherapy