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Indications for transplantation in childhood acute leukemia and the impact of minimal residual disease on relapse: a review

MS Thakar, JAM Talano, RL Tower, ME Kelly, MJ Burke

Allogeneic hematopoietic cell transplantation (HCT) for pediatric acute leukemia continues to offer a cure for some patients with high-risk or relapsed disease. Presently, HCT in first remission is recommended only for patients with predicted leukemia-free survival <50%. Despite recent advances, relapse remains the biggest hurdle in HCT. Minimal residual disease (MRD) identified pre-HCT is one of the strongest predictors for relapse for both acute lymphoblastic leukemia and acute myeloid leukemia. Therefore, novel approaches are needed to eliminate pre- HCT MRD, safely bridging patients to HCT and diminishing relapse. This review highlights the current outcomes for HCT in pediatric acute leukemia, describing the current indications for HCT as well as the significant impact pre-HCT MRD has on relapse for these patients.