Maisonneuve-Rosemont Hospital Université de Montréal

Acute lymphoid leukemia

First remission

Allogeneic transplant from a HLA identical related donor

All patients ≤ 55 years old are eligible in 1st CR

Related or unrelated donor transplant: up until 60 years old if a poor prognostic feature is present

Timing of transplantation

The patient will ideally proceed to transplant after 1 cycle of consolidation.

CNS prophylaxis

If a donor has been identified and the intent is to proceed with transplant in 1st CR avoid prophylactic cranial radiotherapy if TBI is planned. However, the patient must receive adequate CNS prophylaxis (for example: 5 LPs with IT chemo). Ideally, the LPs should be completed pre transplant however they could be completed post transplant if needed. If a donor has not been identified (for example: an unrelated donor search is ongoing), it is recommended to proceed with prophylactic cranial radiotherapy at a dose of 18Gy. The maximal dose given should be 20Gy. We avoid giving 24Gy especially if there is a possibility of TBI in the near future.

Second or third complete remission

Please note that if a patient is between the ages of 50 and 60, he/she will be eligible for an unrelated donor transplant only if there is no significant comorbidity and the donor is at least a 9/10 match (DQ mismatch allowed).

CNS prophylaxis

The patient must have received adequate CNS prophylaxis post relapse (for example: 5 LPs with IT chemo). If the patient has not received all his doses of IT chemo pre transplant, he/she may receive the remainder post transplant as long as there is a negative LP pre transplant (prior to starting the preparative regimen). If cranial radiotherapy needs to be given prior to transplant and TBI is planned we recommend giving 18Gy (max 20Gy).