Should anyone with Philadelphia chromosome-positive ALL who is negative for minimal residual disease receive a hematopoietic stem cell transplant in first remission?

Outcomes for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) in the pre-imatinib era were poor, particularly if patients did not receive an allogeneic hematopoietic stem cell transplant. This led to the recommendation that all patients with Ph+ ALL, if they were transplant candidates, should be transplanted. With the introduction of imatinib and subsequently other tyrosine kinase inhibitors, patient outcomes improved dramatically, raising the question of whether transplant in first complete molecular remission for these patients is really necessary. This review looks at evidence from clinical studies around the world in an attempt to answer this question.