Table of Contents
It has been concluded that hematopoietic stem cell transplantation is one of the fundamental curing procedures for ALL (acute lymphoblastic leukemia). Cyclophosphamide use after a transplant has also been on the rise in the younger adults with the condition of acute lymphoblastic leukaemia though its specific role is yet to be determined.
The analysis’s main objective was to derive and synthesize established studies about stem cell transplants’ effects with associated donor transplants together with unrelated donors for ALL on younger adults.
1.3 Data Sources
The primary information sources were Google Scholar, Science Direct, PubMed, and Cochrane Library. These platforms have the necessary articles appropriate for the study. The keywords used during the research included haploidentical, acute lymphoblastic leukaemia, and cyclophosphamide.
Literature studies of HSCT (haploidentical stem cell transplantation) are eligible for this meta-analysis for acute lymphoblastic leukaemia
1.5 Data Extraction and Synthesis
The study applied pooled odds ratios which were computed by applying the random-effects model. The analysis applied both qualitative and quantitative approaches in extracting the relevant data from the selected articles.
1.6 Main Outcomes and Measures
The primary outcomes for the study were relapse, all-cause mortality and non-relapse mortality,
The study evaluated a total of 26 reports. In total, 22,974 participants participated in all studies. The study primarily compared the increases in all-cause mortality compared with matching associated donors, comparable all-cause mortality compared to matched unrelated donors, and decreases in all-cause life compared to unrelated donors have been combined to treat haploidentical stem cell transplants and post-transplant cyclophosphane. In non-relapse mortality, haploidentical stem cell transplants were linked to worse results than matching related donors in the post-transplant treatment of cyclophosphamide. However, the results were better than matched non-related donors and inappropriately associated donors.
1.8 Conclusions and Relevance
The study indicates that the optimum donor conditions for haploidentical stem cell transplant involve matching associated donors with post-transplant cyclophosphamide therapy.
2.1 Problem Description
Acute lymphoblastic leukaemia is also known as acute lymphocytic. The disorder primarily occurs in the circumstance that a given tissue produces too many unprocessed lymphocytes in the white blood cell. The disorder is commonly associated with young adult s and children but it is rare among the adults, one in three adults. The cure rates for children and young adults is higher and are at 80% while the cure rates for the adults is lower to just between 20% and 40% and are often associated with conditions of dismal prognosis and relapses. Such could get related to the factors associated with the disease relapse and chemotherapy resistance brought because of the adverse genetic features among the adults. Immature lymphocytes accumulate in the lymph tissue and are caused by the genetic variations and chromosomal deformities occurring during differentiation together with proliferation of the lymphoid precursor. When this happens, it results in the overproduction of the immature lymphocytes in the lymph tissue. The tissues swell, hindering the bone marrow from forming the other blood cells. Consequently, the reduced number of red blood cells in the respective human body resulting from bone marrow malfunctioning leads to anaemia. The bone marrow cannot even produce platelets that induce coagulation, making it easier for the body to bleed and bleed (Esparza & Kathleen, 2005).
Lymphocytes may invade other body parts and organs, affecting their proper functioning (Schwab et al., 2007). The bone marrow produces both B and T lymphocytes. However, T lymphocytes mature in the thymus. The two lymphocytes are different in that B lymphocytes could recognize the surface antigens of viruses and bacteria. In contrast, T lymphocytes, on the other hand, recognizes only the viral antigens outside the infected cells.
The leukemic cells can begin in either B or T In either B or T lymphocytes. Approximately 80% of all the cases start with premature B cells. Mature B cells are 1 to 2%. The malignant T cell precursors account for approximately 15% to 20% of all cases. The above cases are common only with the older men and who would require higher levels of chemotherapy. Chromosomes also play a significant role in diagnosing the ALL subtype. The fusion gene TEL-AML1 can specify an early-B leukemia type cell. ALL people who have this gene will be diagnosed with a higher WBC count and a lower prognosis. About 80% of child ALL cases require a rearrangement of the MLL gene; on the other hand, the prognosis is low when high-intensity chemotherapeutics are used. Only a 20% survival rate can be guaranteed (Esparza & Kathleen, 2005).
Cases of ALL are common in children and young adults. The condition is rare among relatively older adults (Hunger & Mullighan, 2015). Studies reveal that acute childhood lymphoblast leukemia also has remission levels above 80%. The rate of recurrence in adult patients has been significantly reduced to between 20 and 40 percent. The disorder’s pathophysiology’s unique variations are encountered between childhood and adult acute lymphoblastic leukemia cases (Faderl et al., 2010). These patient populations are only predisposed to chemotherapy resistance by the adverse genetic characteristics present in older adults, thus raising the recurrence risk after the initial complete remission.
Besides, the high incidence of comorbidity and side effects caused by the treatment are other factors that may lead to failure in this age group. ALL is a common type of cancer affecting both children and young adults. Approximately 3 out of 4 (75%) teenagers and children diagnosed with leukemia are diagnosed with ALL. Most of these cases are experienced with children between 2 and 5 years. The survival rate for ALL has greatly improved over the past couple of years to almost 90%. Those children who survive five years after getting diagnosed with ALL are considered cured and free as it is a rare case that the condition reoccurs after the five years have elapsed.
2.2 Intervention Description
Healthcare professionals employ unique interventions to combat the situation. Healthcare professionals often encounter a lot of technical challenges during the whole treatment process. Although allogeneic stem cell transplantation indications and timing are controversial, it is the accepted care recommendation for all patients who experience mutual dependence, not just those at high risk (Pavlovsky et al., 2019).
Different health challenges attract unique healthcare interventions to ensure success. For instance, patients with advanced hematologic malignancies require specific interventions to improve their health. In this case, healthcare professionals employ HSCT (Hematopoietic stem cell transplantation) as most preferred treatment procedure (Bayraktar et al., 2011). Even though the intervention requires the respective patients to have a matched related donor, many patients do not get such individuals. The healthcare professionals involve a matched unrelated donor (MUD) because the respective transplant outcomes are similar. However, the chance of acquiring MUD is significantly low due to biological diversity among individuals. The process of searching for a MUD in the case of non-Caucasian patients is quite challenging and expensive.
The process of identifying a matched donor is even more challenging when the respective patient emanates from a mixed-race family lineage (Barker et al., 2019). Due to these challenges, healthcare professionals employ the haploidentical stem cell transplantation approach. This approach requires the patient to identify a close relative who matches in at least a single human leukocyte antigen (HLA) haplotype (McCurdy & Luznik, 2019).
A haploidentical treatment is an allogeneic transplant type that uses a semi-assembled donor to replace unhealthy blood-forming cells. In this case, the donor is usually a member of the respective family. Your doctor will test your blood to find the human antigen leukocyte (HLA) type in the case of allogeneic transplants. In several of the cells of the body, HLA is a protein — or marker — found. Doctors search for a blood donor or umbilical cord that fits the HLA closely. But a similar HLA match can often not be found. A haploidentical transplant could then be an option. The donor corresponds precisely with the part of your HLA, a form of allogeneic transplant (Santoro & Ruggeri, 2017).
However, extensive studies have indicated that matched unrelated donors or siblings prove to be the most appropriate donors in the event of a medical transplant. The scenario is not only limited to haploidentical stem cell transplantation. A haploidentical or cord blood donor can be used as a possible option if the respective patient lacks a matching relative or a matched unrelated donor. Matching is when the human leukocyte antigens (HLAs) get tested from tissue or blood samples. The process is fundamental as it assists healthcare professionals in understanding the patient tissue type.
Haploidentical cell hematopoietic transplantation is among the favoured treatment approaches to acute lymphoblastic leukaemia. The HLA matching gets conducted before a donor’s organ transplant or stem cell to find whether they match with the patient who is set to receive the transplant.
Therefore, the approach is commonly utilized to assist patients in undergoing stem cell transplants. In this case, most patients are generally provided with haploidentical donors such as siblings, infants, parents, and families (Kingebiel, et al., 2010). There is also easy access to other forms of adoptive cell therapy or alternative stem cell donations. Besides, the Unmanipulated T-cell depletion grafts are also commonly utilized. In particular, they were used over the past decade and, more often than not, are also used as the store of diseases in addition to anti-thymocyte globulins and cyclophosphamides after transplantation. Optimization of conditions extends application of haploidentical cell transplants for older patients who have significant pre-transplantation (Kingebiel, et al., 2010). The condition does not always occur in all situations but most frequently among the patients with stem cell donors.
Several studies have shown significant findings between haploidentical stem cell transplants, cord blood together with mismatched unrelated donors transplants in ALL patients. Nagler et al. stated that there were positive results from conjunction with host and graft disease in all adults experiencing ALL.
2.3 Importance of the review
The healthcare industry continually undergoes gradual changes due to various dynamics. Various external factors result in more complicated health conditions that require specialized care (Ben et al., 2019). Through this review, healthcare scholars and professionals would acquire more relevant information in controlling the emerging health problems. Notably, the results obtained through this review could be employed to assess the effectiveness of HSCT (Haploidentical stem cell transplantation) compared with other alternatives. The approach can prevent host and graft disease in ALL with Cyclophosphamide. Moreover, this analysis can be helpful and in guiding potential researchers.
Researchers employ multiple approaches to gain the necessary data. In particular, primary and secondary research methods are utilized to gain more information and facilitate quality improvement. Secondary research utilizes the existing qualitative and quantitative data to formulate new findings (Sherif, 2018). Therefore, this review’s results could be used as secondary data sources, hence healthcare and treatment systems.
This study focuses on the assessment and effectiveness of acute lymphoblastic leukemia haploidentical stem-cell transport in younger adults. The study also bases on T-cell depletion and treatment of GVHD prophylaxis complications and complete T-transplants.
The information was reported under the Systematic Reviews and Meta-Analysis Guideline as per the preferred reporting items. A search was carried out using Medline, Google Scholar, PubMed, Science direct, and the Cochrane library. All these platforms have multiple articles explaining HSCT and its effects to respective patients. The American Society of Haematology, the American Society for Transplant and Cellular Therapy, and ESB used in the research. An in-depth analysis of the previous research articles was also carried out to provide more information regarding the topic.
Various scholarly platforms and websites provide a wide range of healthcare information. Researchers should embrace specific strategies to obtain the most relevant information. For instance, some of the approaches that were embraced in this study include choosing search terms, using specific keywords, utilizing exact phrases, searching with subject headings, and utilizing Boolean logic (Aromataris & Riitano, 2014). The use of a combination of these elements assists in achieving the most critical aspects of the article. Throughout this study, all the above aspects were utilized to obtain more information on the topic. Specifically, the study maximized the use of specific keywords and exact phrases to search for the content. Acute leukemia, cyclophosphamide, blood and marrow research, and treatment of GVHD have been extensively utilized. However, the study also used additional keywords to get specified details concerning the topic.
4.1 Study selection and data extraction
The majority of the research reviewed for this analysis was retrospective register-based testing conducted in the last two decades (2000 and 2020) among patients diagnosed with ALL. Specific professionals together with scholars published the selected articles and study materials. Moreover, the EBMT, a collection of over 500 transplantation centers, was included in every checked paper. These centers need a report and follow-up at least once a year on all successive stem cell transplantations. Routine audits are carried out to assess the quality of the data collected. Titles, abstracts, and texts from related papers were reviewed for the study based on the exclusion and inclusion requirements. A comparable study was included if it adhered to the following conditions. Firstly, adult leukemia patients with acute lymphoblastic. Secondly, retrospective/forward-looking trials with more than ten haploidentical stem cell transplantation participants undergoing post-transplant cyclophosphamide treatment.
Notably, the study included the following information: the author’s names, nature of the study, year of publication, the graft versus the prophylaxis of host disease, the types of transplants, the type of marrow source, the transplantation disease status, the number of participants, the kind of conditioning scheme and the follow-up treatment period. The most popular endpoints for the synthesis included mortality all-cause, non-relapse, relapse, chronic operation room, and retrieval free graft.
The quality of secondary data sources determines the value of the respective research. Therefore, utilizing broad and more informative secondary data sources results in more informative studies. The time and accuracy of a given scholarly resource contribute to the respective study’s quality (Field & Gillett, 2010). This study has maintained a close observation of the sources utilized in achieving the best outcomes. Remarkably, the inclusion criteria eliminated all the possible erroneous and vague resources that could reduce the research quality. The healthcare sector is quite extensive and essential. Therefore, providing misleading information could result in significant adverse effects.
4.2 Statistical analysis
Leukemia-free survival was the main objective of all interventions listed in the articles reviewed (LFS). Operation room survival (OS), refined vs. host free graft, graffiti vs. host disease, were the secondary target to evaluate the operation room survival of the graft against host diseases (NRM). Leukemia-free survival can be described as the interval elapsed from either death or relapse in the remission of the haploidentical stem cell transplant. The operation room survival of all causes can be defined as the time to die. The CI (Cumulative incidence) of relapse got calculated from the date of transplant date through to death or relapse in remission. A grade of 3-4 in host disease vs acute graft, and death caused by any stem cell transplant can be classified as relapse-free survival. A multivariate analysis method was applied in all selected studies using the Cox proportional hazards model, including them only if fundamental to the model.
4.3 The criterion for including studies in the review
When selecting studies to include in a systemic review, it is necessary to include high-quality research. The respective researchers embrace specific selection criteria to ensure that all studies selected can be compared and have the same goal to obtain these studies. The types of participants included in this study had to comply with a specific age. 18-35 was the younger adult target group that we were specifically interested in analyzing in this review.
<18 was viewed as children. >35 were considered as older adults. Even though we were only interested in the younger adult target group, the other two groups functioned as control groups to ensure this review’s specificity and validity. The participants were also diagnosed with acute lymphoblastic leukemia. To increase our credibility, we further specialized our criteria to include first-time diagnosed participants and not patients relapsing. However, relapsing patients were not entirely excluded based on diversity and ensuring accurate statements. The study embraced all these measures to ensure effective selection of the study participants, enhancing the quality of results. By eradicating ambiguity and other sources of errors through specific inclusion criteria, the study realized reliable and believable results.
The results provided 2315 citations obtained from the databases searched together with the other sources. The researchers used the titles and abstracts of the respective scholarly resource to screen for the citations. The study excluded 217 (9.3%) citations that did not meet the required criteria. The main reasons for excluding these articles are; using the pediatric population as the target group, lack of comprehensive results, haploidentical group that is not restricted to patients receiving cyclophosphamide as the only post-transplant treatment.
This study included thirty studies in total (n = 30). The 26 (87%) studies that were chosen had a total of 22 974 participants. The median age for the participants was 17 (range 2-25). Most of the patients had a KPS (Karnofsky performance status) ≥92%. One of the researches chosen was prospective, while the other twenty-five were retrospective. Match related donors only 36% (9 studies), matched unrelated donors only 24% (6 studies), matched associated donors and matched unrelated donors had 28% (7 studies), mismatched unrelated donors had 4% (1 study), matched unrelated donors, and mismatched unrelated donors and mismatched unrelated donors 8% (2 studies) are the reference groups for HSCT with cyclophosphamide as a post-transplant treatment (one study). Five studies (20%) applied peripheral blood to be the source of marrow. In comparison, three studies analysed bone marrow transplants when it came to HSCT using cyclophosphamide for post-transplant treatment. Sequence ranged from 1.5 and 4 years.
The figure below will show a systemic review flow diagram
5.1 Mortality and Relapse
Patients who had available information (n=25), 19 (76%) patients had B ALL characteristics while 6 (24%) had T ALL conditions. The disease status at the transplantation centre was CR1 from 15 (60%), full or second remission (CR2+) had 8 (32%) and active diseases 2 (8%).
The study also applied Cytogenetic analysis in 24 patients; 10 (42%) and 14 (68%) were positive and negative respectively. Complete karyotype was recorded for 12 patients. 4 (33%) and 8 (67%) had an abnormal and a normal karyotype respectively. Among the most frequent alterations included (n=2) t(4;11), (n=3) t(12;21) while t(1;19) (n=4).
Follow-up in months. Median Range 60
Age of patients in years Median range 17
Years for Research Range 2000-2020
Patient Gender Male 14 (46%)
Female 16 (54%)
Karnofsky performance status ≥92%
Cytogenetics Normal karyotype 4
Abnormal karyotype 8
Negative Ph. 58%
Positive Ph. 42%
The Median Donor age range 31 (11-68)
Donor Kinship Siblings 7 (28%)
Parents 11 (44%)
Child 8 (28%)
Disease status CR1 15 (60%)
CR2+ 8 (32%)
Active cases 2 (8%)
The patients who had t(9;22) mostly applied TKI (tyrosine kinase inhibitors), 7 patients before transplant while 2 patients after transplant respectively.
MRD was available for 17 out of 24 patients in CR and 9 (53%) confirmed to be MRD positive.
The cumulative recurrence was 1.06. The value was 1.17 relatives to matched donors and 1.06 in comparison to matching donors. Cyclophosphamide haploidentical stem cell transplantation (SCT) was combined to better effects than unrelated donors as a post-transplant therapy, with a recurrence of 0.79 in general. From 24 of the 26 studies selected, non-relapse mortality was evaluated. The total recurrence was 0.88. Cyclophosphamide haploidentical stem cell transplant got linked with increased non-relapse mortality as a post-transplant treatment, compared with the average 1.20 relapse rate of the matched relapse donor.
Figure: Pie chart showing Average recurrence
Relapse was assessed in 25 of the 26 selected studies. The overall operation room relapse was 1.09. In the case of the pooled operation room relapse analysis, applying the HSCT with cyclophosphamide as treatment proved to be associated with almost similar outcomes seen in relapse when the data was compared with matched related mismatched unrelated donors. The HSCT with cyclophosphamide as a treatment got linked with increased degeneration when compared to matched unrelated donors exhibiting a pooled operation room relapse of 1.20 (Raiola et al., 2018).
5.2 Chronic GVHD
Twenty-three studies were consisting of 17,115 patients in total got assessed for the disease. After conducting an extensive analysis, it was concluded that HSCT with cyclophosphamide as a treatment was associated with better outcomes. The conclusion was based on the significance of patient outcomes obtained upon application of the intervention.
5.3 Acute GVHD
Twenty reports constituted 13,795 gross acute graft-assessed patients relative to grades 3-4 host disease. After a conclusive analysis, it had been concluded that the acute graft reduction versus host disease reported degrees 3 to 4 which were directly associated with haploidentical cells transplantation with cyclophosphamide as a post-transplant therapy. Consequently, twenty-two studies constituted 16,389 AG (Acute graft) against the host disease grade 2-4 patients. The respective treatments were used. The clinical outcomes during and after the treatments were retrospectively evaluated and the follow-up among the patients got conducted after five years. The subsequent results showed that less than a third of the patient population had shown signs of reduced-intensity in the chemoregimen. Grade three and grade four acute GVHD was 22% and 37% respectively. The overall survival for the 60 month period was 43% and 34% for the sibling donors and unrelated donors respectively.
The study included 26 studies in which the available literature on acute lymphoblastic leukemia was reviewed in 22 974 patients. Results of HCSCT (Haploidentical cyclophosphamide stem cell transplantation) for post-transplant care that had matched or mixed donors were summarized and analyzed for precise findings. As described in the previous results, haploidentical stem cell transplants were related to reduced host disease vs. chronic graft with cyclophosphamide for post-transparent care. Transplantation of HSC (Haploidentical stem cells) along with cyclophosphamide was correlated with decreased non-relapse mortality. However, there was an increased rebound in comparison with matching unrelated donors. The employment of HSCT by applying cyclophosphamide is entirely preferred as post-transplant treatment approach. Therefore, the approach is quite beneficial to the respective patients.
According to the identified articles, it is evident that HSCT and cyclophosphamide are the preferred treatment methods. A total of 15 of the 26 selected studies were published from 2000 to 2020. Most of these studies indicated that the most efficient choice for patients without a matched sibling or an alternative of unrelated donor is the HSCT along including after transplant cyclophosphamide care. HSCT could result in lasting positive patient outcomes. The underlying practices that are involved during this treatment approach contribute to its tremendous positive impacts. Notably, the method utilizes specific blood-forming cells extracted from the identified half-matched donor (Ricci et al., 2014). Using these cells to replacing the unhealthy ones in the respective patient’s body significantly improves their immunity. Therefore, the underlying activities and theories supporting the application of haploidentical stem cell transplant result in its success.
On the other hand, cyclophosphamide can be used after transplant at 50 mg/kg/d 3 to 4 days. It can be used alone or in combination with other graft compared with prophylactic agents for host illness, depending on their characteristics as well as the types of the donor (Luznik et al., 2010). Historically, cyclophosphamide is considered to prevent extreme acute but even chronic graft versus host illness, usually minimizing the need for some other immunosuppressant agent. More recent findings indicate that cyclophosphamide cannot wholly kill T-cells as a post-transplant therapy.
The findings of this systematic analysis will improve the evidence that haploidentical stem cell transplantation with cyclophosphamide can serve as an alternative to paired, unrelated donor transplants as post-transplant therapy. These transplants also include improved donor availability, quicker graft collection, and shorter time between collection and infusion. This practice will make the second transplant process simpler by making donations easier to receive. For the case of relapse, it tends to be correlated to increased relapse patient rates when used along with cyclophosphamide in post-transplantation.
Deducing from the findings above, the most common treatment post-remission to younger adult patients having ALL is SCT (Stem cell transplantation). It is also a favoured treatment in patients in critical condition, particularly those who suffer from recurrence, steroid or chemical resistance, and relapse following initial CR (Aints, 2002). Several studies have confirmed a 5- years free leukaemia survival in patients who receive a matched sibling or matched non-identified donor allogeneic transplantation.
An equivalent donor could only explore options for a substantial proportion of the patients interested in the trials. These methods include either unrelated or haploidentical donor transplantation. Thanks to the advanced technology used to scan unrelated donors, this process could be arranged relatively quickly. A systematic review of the findings to achieve possible benefits and drawbacks related to the increased risk of immune-related complications would confirm the call for HSCT. Results from the study reports indicate that the treatment in question is credible and thriving in this high-risk disease. I found no variations in the results using GVHD prophylaxis used during this analysis, but this did not achieve statistical importance. Therefore, it is clear that both types of GVHD prophylaxis are successful in adults with ALL. All the scholarly articles utilized during the study greatly support using the best available approaches in enhancing positive patient outcomes. Primarily, Acute Lymphoblastic leukemia gets regarded as cancer affecting blood cells’ lymphoid line. One of the disease’s main effects is the massive production of immature lymphocytes (Mullighan et al., 2008).
This therapy’s effect on the disease’s re-occurrence is still not understood and can differ in diagnosis and disease status from patient to patient. This phenomenon explains why more research on diagnosis and treatment is necessary. The study was conducted with acute lymphoblastic leukaemia on younger adult individuals.
The disease status, as mentioned above, was a significant factor in taking the prognosis of repetition and survival into account. The outcomes of CR1-treated patients can be compared to the HLA-matched stem cell transplantation results, although the results are still very low in acute disease patients. However, with HSCT, there is still inadequate evidence in patients having advanced disease; the likelihood of leukemia-free survival is estimated to be 28 percent.
The study conducted by Gorin et al. (2020), it is clear that the results from the patients with resistant or refractory disease got influenced by the recipient’s gender and conditioning combinations. The procedure had better female donor when compared to male donor results. On the contrary, in a recently conducted studies, there was no impact on the intensity nor the type of conditioning affected the outcomes. Modern methods such as bi-specific, anti-CD22, or anti-CD22 have been more widely used to bridge a significant number of chronic patients to stem cell transplants (Zhao et al., 2019). Chimeric Antigen Receptor (T) cells also emerges as a choice of treatment for malignant lymphoid patients with typical chemotherapy resistance
Additionally, more studies showed a substantially reduced risk of relapse that was experienced from female donors to a male recipients, without any substantial effect on results. This scenario indicates that acute lymphoblastic leukaemia is particularly sensitive to graft-versus leukemia’s reaction to the Y chromosome’s slight antigenic mismatches.
Therefore, it can be concluded from this review that the type of stem cell source applied in HSCT showed no difference when comparing the incidence of graft versus host disease and the patient’s survival. It also indicates that the stem cells’ source directly impacts the HSCT outcome among young adults with ALL. Peripheral blood had a considerably higher risk of host disease vs. graft, which resulted to a decreased survival rate as well as leukemia-free survival.
The effects stem cell source to the possible results of treatment requires further research. The topic needs urgent attention due to the rapid increase of haploidentical stem cell transplantation in our modern times. Due to various health dynamics in modern society, more individuals encounter more health problems that require haploidentical stem cell transplantation. Moreover, the approach is utilized in treating both malignant and non-malignant conditions among patients (Copelan, 2006). The outstanding success level of using this method in treating multiple health prompt the respective healthcare professionals to conduct further research to maximize its effectiveness.
In this review, there might be various factors which might have been omitted leading to limitations. Most of the reviewed studies consisted of a homogenous population in terms of the diagnosis, although acute lymphoblastic leukemia is a heterogeneous disease. TKI (Tyrosine kinase inhibitors) were also used in the curing of acute lymphoblastic leukemia. The procedures are also recommended in post-stem cell transplantation prophylaxis, which may influence the operation room results.
Finally, this systematic analysis shows that haploidentical stem cell transplant gets regarded as a practical choice for younger adults with acute lymphoblastic leukaemia (Hunger & Mullighan, 2015). It is also beneficial to quickly get donor to assist avoiding in the possibilities of retrogress. The best donor for mortality after SCT were found as matched linked contributors. The results presented in this review showed that HSCT with cyclophosphamide therapy as the most preferred post-transplant treatment (Nagler et al., 2021). Further investigation to determine the exact role of HSCT with cyclophosphamide as a post-transplant treatment concerning relapse is needed. This summary could facilitate clinical reasoning and hopefully assist in the design and understanding of future trials. Besides, the study showed a substantially reduced risk of relapse on female to male, without any substantial effect on results. Therefore, acute lymphoblastic leukemia is particularly sensitive to graft-versus leukemia reaction related to the Y chromosome’s minor antigenic mismatches.
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