Allogeneic Transplantation of Hematopoietic Stem Cells (HSCs) for Acute Leukemia in Children – Review of Literature and Experience of Single Center in Russia

Abstract

The indications for hematopoietic stem cell transplantation (HSCT) in pediatric leukemias continually change with the risk-stratification-based treatment improvement. Achieving the minimal residual disease (MRD) negativity before transplantation, using RSI when it’s appropriate, accurate management of post-transplant complications and GVHD are the factors of improving transplantation outcomes. Graft engineering methods are being worldwide investigated also to make HSCT more effective and less toxic, but still there is no gold standard of graft. Use of haploidentical grafts from relatives is a quick and cost-effective option of anti-leukemic efficacy achievement. Upon our experience in Russian Cancer Center, we believe that differentiated diagnosis-based approach to conditioning regimens in haplo-HSCT setting along with maintaining the manageable level of chronic GVHD could provide positive results in pediatric patients with prognostically the most unfavorable leukemias.