Transplants for leukemia in relapse: When is the best time?

Transplantation of hematopoietic cells to treat acute leukemia can offer disease control and extended survival for a sizeable fraction of patients, but because alternative approaches may also be effective, the decision about transplant timing remains uncertain. For those transplanted in first complete remission (CR1), outcomes are the best, but some fraction of those might have had extended leukemia-free survival in the absence of a transplant. In later remission, outcomes are variable but promising—and markedly better than any nontransplant approach. Risks of relapse may differ based on the depth of remission, measurable minimal residual disease (MRD), or patient’s performance status.