Allogeneic Stem-Cell Transplantation in Children and Adolescents with Malignancies

Allogeneic haematopoietic stem-cell transplantation (HSCT) is of benefit for children and adolescents affected with malignancies which are refractory to conventional chemotherapy. Since the first HSCT took place in 1957 and human leukocyte antigen (HLA) genetics were unravelled, thousands of patients have been virtually cured from their disease after undergoing HSCT. Eligibility criteria, donor selection, stem-cell source, conditioning regimen, graft-versus-host disease (GvHD) prophylaxis, and supportive therapy evolved over time and contributed to the reduction in transplant-related mortality. In this chapter, alternative donors are mentioned and the excursus which led to ongoing haploidentical HSCT approaches are detailed. Issues related to HSCT in acute lymphoblastic leukaemia (ALL) (the most frequent indication for HSCT in paediatrics), acute myeloid leukaemia, and solid tumours are discussed. The impact of minimal residual disease on HSCT outcome in ALL, strategies to exploit the graft-versus-tumour effect in solid tumours, and post-HSCT immunotherapy are highlighted.