{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T01:25:43Z","timestamp":1790040343143,"version":"4.0.1"},"reference-count":42,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T00:00:00Z","timestamp":1742342400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>The treatment of B-cell acute lymphoblastic leukemia (B-ALL) in adults remains a significant therapeutic challenge. While advances in chemotherapy and targeted and immunotherapies have improved overall survival, relapsed or refractory (r\/r) adult ALL is associated with poor outcomes. CD19-directed chimeric antigen receptor (CAR) T-cell therapy has emerged as a transformative option, achieving high remission rates even in heavily pretreated patients. However, relapse is common. Allogeneic hematopoietic stem cell transplantation (allo-HCT), a traditional cornerstone of remission consolidation, may improve long-term outcomes but carries risks of transplant-related mortality (TRM) and morbidity. Most evidence for HCT after CAR T therapy comes from retrospective analyses of subgroups from CAR T cell trials, with small sample sizes and inconsistent data on transplant procedures and outcomes. Despite these limitations, consolidative allo-HCT appears to prolong relapse-free survival (RFS). While overall survival (OS) benefits are in question, extended remission duration has been observed. Nonrelapse mortality (including TRM), ranging from 2.4 to 35%, underscores the need for careful patient selection. Emerging real-world data affirm these findings but highlight the importance of individualized decisions based on disease and treatment history. This review examines current evidence on the sequential use of CD19-directed CAR T-cell therapy and allo-HCT in adults with r\/r B-ALL.<\/jats:p>","DOI":"10.3390\/curroncol32030177","type":"journal-article","created":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T06:10:53Z","timestamp":1742364653000},"page":"177","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Changing Role of Allogeneic Stem Cell Transplantation in Adult B-ALL in the Era of CAR T Cell Therapy"],"prefix":"10.3390","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5371-3643","authenticated-orcid":false,"given":"Jana","family":"van den Berg","sequence":"first","affiliation":[{"name":"Division of Hematology, University Hospital Basel, CH-4031 Basel, Switzerland"},{"name":"Innovation Focus Cell Therapies, University Hospital Basel, CH-4031 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Meloni","sequence":"additional","affiliation":[{"name":"Division of Hematology, University Hospital Basel, CH-4031 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Halter","sequence":"additional","affiliation":[{"name":"Division of Hematology, University Hospital Basel, CH-4031 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob R.","family":"Passweg","sequence":"additional","affiliation":[{"name":"Division of Hematology, University Hospital Basel, CH-4031 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Holbro","sequence":"additional","affiliation":[{"name":"Division of Hematology, University Hospital Basel, CH-4031 Basel, Switzerland"},{"name":"Innovation Focus Cell Therapies, University Hospital Basel, CH-4031 Basel, Switzerland"},{"name":"Regional Blood Transfusion Service, Swiss Red Cross, CH-4056 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e170580","DOI":"10.1001\/jamaoncol.2017.0580","article-title":"Association of Minimal Residual Disease with Clinical Outcome in Pediatric and Adult Acute Lymphoblastic Leukemia: A Meta-analysis","volume":"3","author":"Berry","year":"2017","journal-title":"JAMA Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.1182\/blood.2023023568","article-title":"Management of ALL in Adults: 2023 ELN Recommendations from a European Expert Panel","volume":"143","author":"Boissel","year":"2024","journal-title":"Blood"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1524","DOI":"10.3324\/haematol.2016.144311","article-title":"International reference analysis of outcomes in adults with B-precursor Ph-negative relapsed\/refractory acute lymphoblastic leukemia","volume":"101","author":"Dombret","year":"2016","journal-title":"Haematologica"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1056\/NEJMoa1609783","article-title":"Blinatumomab versus Chemotherapy for Advanced Acute Lymphoblastic Leukemia","volume":"376","author":"Kantarjian","year":"2017","journal-title":"N. 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