Patient’s question: I was found to have a leukocyte count of 1.4 in my physical examination, but I didn’t care because I didn’t feel well. One month later, I had a fever of over 37 degrees, and went to the clinic to get an antipyretic injection that did not go down. I went to the hospital for a routine blood test, and the white blood cell count was 1.25. Now the first course of chemotherapy is completed, my bone marrow leukemia cells have decreased from more than 40% to 0.5%, and I am preparing for the second course, I am 20 years old, male. I have heard that the prognosis for adults with acute leukemia is not good, and I am worried about the risk of transplantation, but I am an only child, can I use my parents’ transplant? Is the success rate of semi-identical transplantation higher, or is the success rate of a donor from a bone marrow bank higher? What is the long-term survival rate if the transplant is successful? What is the long-term productivity if I choose chemotherapy? Response: In acute lymphocytic leukemia, the prognosis is generally better for children between the ages of 2 and 10, and with proper treatment, the long-term survival rate can be up to 80%, and the prognosis for adolescents with acute lymphocytic leukemia is better than that of patients older than 40. Of course, besides age, there are other factors that determine the patient’s prognosis, such as the type of acute leukemia, chromosomal and genetic abnormalities, the patient’s general condition, etc., which need to be analyzed on a case-by-case basis. The fact that you have not found any relevant genetic abnormalities indicates that it is not a leukemia with a poor prognosis such as Ph+ acute gonorrhea. In either case, you should receive regular induction therapy, intensive consolidation therapy and maintenance therapy for the best outcome; allogeneic hematopoietic stem cell transplantation (the donor is a healthy person) is an important treatment for long-term survival in acute leukemia, and usually has a higher chance of long-term survival than chemotherapy, so you should strive for it during the first complete remission if available. Although allogeneic transplantation carries some risk, the overall chances of long-term survival have increased, especially for younger patients, because the relapse rate has decreased significantly and advances in transplantation technology over the years have reduced the risk of transplantation. You are only 20 years old and it is recommended to try to get transplantation treatment. Considering that in our country, many patients are unable to adhere to a regular full dose and full course of chemotherapy for various reasons, the long-term efficacy of transplantation is more advantageous. There are three choices of transplant donors for only children, unrelated donors from the Chinese Bone Marrow Bank, haplotype-matched (semi-matched) donors from parents or cousins, or cord blood. After the diagnosis of leukemia is confirmed, HLA high-resolution matching should be done, and when the results are available, you can first go to the Chinese bone marrow bank for matching, and at the same time perform HLA matching with your parents to see the results before deciding what donor to use. Before finding a suitable donor for transplantation, intensive treatment should be carried out as planned. Studies now show that haplotype transplantation results in similar outcomes to allogeneic transplantation, with a greater risk of transplantation but less risk of recurrence and similar overall survival rates. Long-term survival rates after successful transplantation vary by transplant unit, from 40%-70%+, as the type of transplantation and the patient’s condition are not quite the same. However, most outcomes have a higher survival rate after transplantation than chemotherapy, especially in younger patients. If chemotherapy alone is given, it is about 20-40%. Patient Question: This is a match between the patient and his parents, is it possible to transplant? If so, is the success rate high? The success rate is higher for hemiploid versus allogeneic allogeneic pairs Reply: You and your parents are haplotypically compatible (hemiploid). The patient’s condition should be analyzed on a case-by-case basis, and it is best to bring all the information about the past treatment to the outpatient clinic for discussion. Patient Question: Can autologous transplantation be done for acute lymphocytic leukemia? Answer: Autologous transplantation has been done, but the results reported vary widely. Generally speaking, allogeneic transplantation has better efficacy than autologous transplantation, and autologous transplantation is not routinely recommended for acute lymphocytic leukemia, which has a higher relapse rate. Of course, the risks associated with autologous transplantation are less, and many clinical studies have shown that the risk of relapse after transplantation is lower than that of chemotherapy, so autologous transplantation may be considered if one is not willing to take the risks associated with allogeneic transplantation and wishes to treat more safely.