Current status of blood and marrow transplantation for patients with AML

Abstract

During the past decade it has become apparent that patients can be transplanted successfully after preparation with regimens of reduced intensity. Reduced intensity preparations have resulted in lower morbidity and mortality during the pre-engraftment period, but have not reduced later occurring infections, GVHD and relapse. Outcome-determining risk factors that characterize patients at diagnosis as well as during their course include age, cytogenetic configuration, hematopoietic elements and a previous history of myelodysplasia or cytoreductive therapy for a pre-existing malignancy. These factors are complemented by the response to induction therapy and subsequent treatments as well as by the duration of the response. More recently, gene expression profiling of leukemic cells has added a new dimension to simultaneously assessed biological risk factors that may ultimately lead to individuation of therapy.

Early allo-SCT for AML with a complex aberrant karyotype—results from a prospective pilot study

“…Due to a significant survival benefit in comparison with the conventional chemotherapy, allogeneic haematopoietic SCT (HSCT) using matched related-or unrelated-donors is the recommended treatment in CK-AML and other unfavourable karyotypes. [4][5][6][7] However, even after standard related HSCT in CR1, unfavourable cytogenetics at diagnosis predicted an inferior outcome. 8,9 In contrast, cytogenetics had less influence after HSCT from matched unrelated donors, arguing for a stronger GvL effect in the unrelated setting.…”

Test Then Erase? Current Status and Future Opportunities for Measurable Residual Disease Testing in Acute Myeloid Leukemia

“…Older adults with AML are more likely to have adverse risk disease, which may be associated with higher rates of MRD [27, 41]. Lack of disease control has been cited as one barrier to transplant [42]. These patients are generally ineligible for standard MAC regimens with high rates of non-relapse mortality (NRM), therefore novel conditioning regimens are needed to address these patients at high risk for relapse with RIC.…”