When is allogeneic stem cell transplant recommended for acute lymphoblastic leukaemia?

An allogeneic transplant replaces diseased or damaged blood-forming cells with stem cells from a donor. Before the infusion, conditioning treatment makes space in the bone marrow and suppresses immune activity. The new immune system can recognise leukaemia cells, but it can also attack healthy tissues. Doctors assess the leukaemia's genetic features, measurable residual disease, response to treatment, age, organ function, previous therapies, and donor match. Some people are considered for transplant in first remission; others need it after relapse or inadequate response.

Ask the haematology team how remission and residual disease results affect timing. Preparation can include donor search, heart and lung checks, infection screening, dental review, fertility counselling, and a plan for medicines after infusion. Arrange practical help for appointments, transport, meals, and monitoring because recovery requires close follow-up. Report new infections and keep vaccinations or medicines aligned with the transplant team's instructions.

During and after transplant, call the transplant unit urgently for fever, shaking chills, breathlessness, confusion, persistent vomiting, severe diarrhoea, bleeding, or a new widespread rash. Mouth sores that prevent drinking and a sudden reduction in urine also need prompt review. These may signal infection, bleeding, organ stress, or graft-versus-host disease, which can worsen quickly when immunity is suppressed.

Ask how my measurable residual disease and genetic findings affect relapse risk; is a donor available; what conditioning approach is planned; how will graft-versus-host disease be prevented and treated; and which symptoms require a same-day call?