Editorial: The latest advances in transplantation for AML

Abstract

Allogeneic stem cell transplantation (alloSCT) is the optimal treatment strategy for adult acute leukemia patients due to its ability to reduce the risk of relapse. The ELN group recommends the consideration of alloSCT in fit adults with AML in CR1 who have a predicted relapse risk of 35 to 40% and a suitable donor (1). Risk stratification is based on clinical factors, such as age and gender, as well as cytogenetic risk based on karyotyping results and more recently on Measurable Residual Disease (MRD) assessment during treatment and mutations of prognostic significance in genes like FLT3, NPM1, ASXL1, RUNX1, and TP53 as described in the 2022 ELN classification.Despite these considerations, disease relapse represents the major cause of treatment failure, so a better stratification of patients based on biological and molecular characteristics, giving the opportunity to optimize conditioning regimen and administrate chemo-immunotherapy after alloSCT, would prevent relapse.An increasing number of genetic and epigenetic abnormalities have been shown to display the prognostic value in acute myeloid leukemia (AML); in this context, in a monocentric experience, (2) focused their attention on the prognostic impact of the mutational pattern of AML on relapse and survival after alloSCT. They found that FLT3, TP53, and WT1 mutations were predictive variables associated with a higher rate of relapse occurrence after transplant. In a retrospective analysis of 96 AML patients, they found that TP53 mutations conferred a four-times risk of relapse. In a Cox regression model for DFS, they found that not only TP53, WT1, and FLT3 but also NRAS mutations were associated with a reduced outcome.Baseline genomic features seem to have an important role in predicting survival regardless of the age of AML patients. On the same topic, (3) in a single-center retrospective study determined the impact of targeted therapy vs intensive chemotherapy on the outcome of AML patients aged 60 to 75, demonstrating that the baseline genomic features together with the transplant procedure are the most important independent predictors of overall survival (OS) in the subset of patients aged 60 to 75.In this context, the intensification of the conditioning regimen may be able to improve the prognosis in terms of better survival. In a retrospective matched pair study, (4) analyzed the role of the combination of decitabine (Dec) and mBuCy for intermediate-and high-risk AML patients undergoing allogeneic stem cell transplantation from a sibling or Frontiers in Oncology frontiersin.org 01