Is There Still a Role for Autologous Stem Cell Transplantation for the Treatment of Acute Myeloid Leukemia?

Abstract

After intensive induction chemotherapy and complete remission achievement, patients with acute myeloid leukemia (AML) are candidates to receive either high-dose cytarabine-based regimens, or autologous (ASCT) or allogeneic (allo-SCT) hematopoietic stem cell transplantations as consolidation treatment. Pretreatment risk classification represents a determinant key of type and intensity of post-remission therapy. Current evidence indicates that allo-SCT represents the treatment of choice for high and intermediate risk patients if clinically eligible, and its use is favored by increasing availability of unrelated or haploidentical donors. On the contrary, the adoption of ASCT is progressively declining, although numerous studies indicate that in favorable risk AML the relapse rate is lower after ASCT than chemotherapy. In addition, the burden of supportive therapy and hospitalization favors ASCT. In this review, we summarize current indications (if any) to ASCT on the basis of molecular genetics at diagnosis and minimal residual disease evaluation after induction/consolidation phase. Finally, we critically discuss the role of ASCT in older patients with AML and acute promyelocytic leukemia.

Postremission therapy with repeated courses of high‐dose cytarabine, idarubicin, and limited autologous stem cell support achieves a very good long‐term outcome in European leukemia net favorable and intermediate‐risk acute myeloid leukemia

“…In intermediate‐risk AML patients, the best post‐remission therapy is highly controversial. According to ELN 2017 recommendations, 4 both intermediate‐dose or HDAC or high doses therapy followed by autologous SCT 13,31–33 or allo‐SCT 34,35 are considered potentially effective. The better knowledge of the heterogeneous molecular landscape of the disease, as well as the recent availability of new agents specifically targeting surface molecules or mutations of the leukemic blast cell has further complicated the choice of the best treatment strategy 36,37 .…”

Evolving Therapeutic Approaches for Older Patients with Acute Myeloid Leukemia in 2021

“…Prospective studies in older AML patients assessing the benefits of autologous SCT compared to chemotherapy consolidation or allogeneic transplantation are lacking. As emerged in previous works, autologous SCT could be safely offered to a selected number of older patients with intermediate-low-risk AML, provided that a consistent number of peripheral blood stem cells (PBSCs) are collected [82][83][84]. As suggested by ELN 2017 guidelines, it could be considered in intermediate-risk patients, and the current GIMEMA strategy is to limit autologous HCT to patients with favorable/intermediate-risk AML and MRD negativity [20,75], although it is mostly reserved for younger patients.…”

Cellules humaines à usage thérapeutique : état de la question

“…Elle est aussi indiquée en cas de rechutes de lymphome hodgkinien et non hodgkinien. Dans le traitement des leucémies aiguës myéloblastique, elle est indiquée chez les patients en première rémission, pour les leucémies à bas risque et avec une maladie résiduelle indétectable [52] . L’allogreffe reste le traitement de référence pour les leucémies aiguës myéloblastiques de l’adulte en première rémission chez ceux qui ont un risque de récidive de 35 à 40 %, en cas d’anomalies cytogénétiques péjoratives ou de myélodysplasie préexistante [53] , [54] .…”