The treatment paradigm for acute lymphomablastic leukemia has been constantly changing. Historically, allogeneic transplantation (alloHCT) has been a mainstay in the treatment for adult ALL patients due to its effectiveness in preventing disease relapse and due to the poorer outcomes of adult ALL treatment protocols compared to pediatric patients. There have been ongoing advances in the treatment of ALL including the use of pediatric-like protocols as well as the incorporation of oncogenomics and MRD-based responses into prognostic models. In addition, in the last decade, there has been a rapid development of immune-based therapies, and three agents inotuzumab, blinatumomab, and chimeric antigenic T-cell therapy (CAR-T) have been approved for the treatment for relapsed ALL. In the field of alloHCT, the use of reduced intensity conditioning and alternative donor sources has improved the accessibility of alloHCT. In this chapter, we review the latest literature addressing these issues and discuss the relevance of alloHCT in this rapidly changing treatment landscape.