Introduction: Allogeneic hematopoietic stem cell transplantation (allo-HSCT), including human leukocyte antigen-matched sibling donor transplantation and alternative donor transplantation, remains a curative approach for patients with ALL. In recent years, the advent of targeted therapy and immunotherapy has changed the transplant indications of ALL, which can also be combined with allografting to further improve transplant outcomes, especially for those with refractory or relapsed ALL.
Areas covered: In this review, we summarized the current status of allo-HSCT for ALL, mainly focusing on transplant indications, donor selection, conditioning regimens, graft-versus-host disease prophylaxis, incorporation of targeted immunotherapy with allografting, and measurable residual disease-directed intervention for transplant outcome improvement. We also discussed challenges, such as post-HSCT leukemia relapse treatment and new strategies for complication-related mortality, as well as future directions of allo-HSCT for ALL.
Expert opinion: Allo-HSCT remains one of the curable therapies for ALL in the era of targeted therapy and immunotherapy. Future directions should focus on decreasing relapse mortality and nonrelapse mortality to further improve the outcomes of patients with ALL.
Keywords: Allogeneic hematopoietic stem cell transplantation; acute lymphoblastic leukemia; immunotherapy; targeted therapy.