Allogeneic hematopoietic cell transplantation is not recommended for all adults with standard-risk acute lymphoblastic leukemia in first complete remission.

Acute lymphoblastic leukemia (ALL) is a heterogeneous disease, and outcomes vary by patient age, immunophenotype, and clinical, cytogenetic, and molecular features. Modern treatment strategies use a risk-adapted approach. The optimal postremission therapy for adults with ALL remains unclear. Treatment-related morbidity and mortality (TRM) are greater with hematopoietic cell transplantation (HCT) than chemotherapy although relapses are less common. Available data indicate no clear consensus as to whether there is an advantage to allogeneic HCT over chemotherapy for adults with ALL with standard-risk features while in the first complete remission (CR1). However, allogeneic HCT is recommended in CR1 for patients with high-risk ALL and for those in a second CR.