Prospective Evaluation of Allogeneic Hematopoietic Stem-Cell Transplantation From Matched Related and Matched Unrelated Donors in Younger Adults With High-Risk Acute Myeloid Leukemia: German-Austrian Trial AMLHD98A

Abstract

Allogeneic HSCT in younger adults with high-risk AML has a significant beneficial impact on outcome, and allogeneic HSCT from MRD and MUD yields similar results.

Outcome of conditioning intensity in acute myeloid leukemia with monosomal karyotype in patients over 45 year‐old: A study from the acute leukemia working party (ALWP) of the European group of blood and marrow transplantation (EBMT)

“…Patients with good risk cytogenetics such as abn [16] or t(8; 21) can be spared from the toxicity of SCT, while patients with high risk cytogenetics appear to benefit from SCT, with an estimated 44% probability of surviving 5 years after CR1, compared with 15% or less after chemotherapy [2]. Several reports have confirmed this significant advantage of SCT in high risk AML, and it is currently highly recommended not to delay SCT in this population [3][4][5]. Among patients with high risk AML, the coexistence of multiple clonal cytogenetic abnormalities, referred to as complex karyotype (CK), has been associated with the worst outcome [6].…”

The European LeukemiaNet AML Working Party consensus statement on allogeneic HSCT for patients with AML in remission: an integrated-risk adapted approach

“…Currently, a number of cooperative groups have incorporated unrelated donor alloHSCT in their protocols for upfront treatment of AML patients, as multiple retrospective and prospective studies have shown that -well matched‖ unrelated donor grafts may be associated with acceptable NRM and strong reduction of relapse in AML CR1 patients (69-76). In the recent prospective study of the German Austrian AML Study Group, equivalent efficacy and NRM was shown in a head to head comparison of matched related and unrelated donor alloHSCT in adult high-risk patients (76). Collectively, these studies suggest that an unrelated donor alloHSCT is justified if the a priori risk of relapse is sufficiently high and the counterbalancing NRM following unrelated donor alloHSCT can be estimated as moderate.…”

“…(86)(87)(88)(89)(90)(91)(92)(93)(94)(95). During the prospective German-Austrian study (76), a growing number of patients received RIC-regimens. Although not randomized, that study prospectively suggested equivalent results in patients receiving RIC or MA regimen in terms of relapse, NRM, and survival.…”

Effect of related donor availability on outcome of AML in the context of related and unrelated hematopoietic cell transplantation

“…Recently, several groups have conducted prospective donor vs no-donor studies for AML patients with high-risk features by expanding the type of donor to include unrelated donors. [19][20][21] Notably, despite a limited number of patients in each study, they showed significantly superior OS in patients with a donor, as well as comparable OS in patients undergoing related and unrelated HCT. [19][20][21] These prospective studies also support the usefulness of unrelated HCT in younger AML patients with non-favorable cytogenetics.…”

“…[19][20][21] Notably, despite a limited number of patients in each study, they showed significantly superior OS in patients with a donor, as well as comparable OS in patients undergoing related and unrelated HCT. [19][20][21] These prospective studies also support the usefulness of unrelated HCT in younger AML patients with non-favorable cytogenetics. Although our multivariate analysis showed that the degree to which allogeneic HCT had favorably affected outcome was less marked in patients without a related donor compared with those with a related donor, unrelated HCT could be considered a reasonable treatment option if a related donor is not available.…”