Revisiting autologous transplantation in acute myeloid leukemia

Ganzel, Chezi; Rowe, Jacob M.

doi:10.1097/moh.0000000000000408

Cited by 11 publications

(7 citation statements)

References 23 publications

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“…In contrast to the increasingly frequent use of allo HCT, the use of auto HCT has been in decline, rarely being recommended in the U.S 132,133 . Nonetheless there are indications that, despite lack of an obvious GVL effect, auto HCT provides more anti AML effect than chemotherapy, at least in “favorable” and intermediate risk patients 134,135 .…”

Section: Therapy Issuesmentioning

confidence: 99%

Acute myeloid leukemia: 2021 update on risk‐stratification and management

Estey

2020

American J Hematol

115

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Management of AML involves choosing between purely palliative care, standard therapy and investigational therapy ("clinical trial"). Even most older patients likely benefit from treatment. Based on randomized trials CPX 351, midostaurin, gemtuzumab ozogamicin, and venetoclax, the latter three when combined with other drugs, should now be considered standard therapy. Knowledge of the likely results with these therapies is essential in deciding whether to recommend them or participate in a clinical trial, possibly including these drugs. Hence here, in the con

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Section: Therapy Issuesmentioning

confidence: 99%

Acute myeloid leukemia: 2021 update on risk‐stratification and management

Estey

2020

American J Hematol

115

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“…Although HDCT/ABSCT has been associated with prolonged DFS, no beneficial effect on OS has been proven thus far. Moreover, the rate of relapse is significantly increased compared to allogeneic TPL [33, 34].…”

Section: Discussionmentioning

confidence: 99%

Cryostorage to What End? – Autologous Stem Cell Products in Burkitt Lymphoma, Acute Lymphoblastic Leukemia, Acute Myeloid Leukemia, and Myeloproliferative Neoplasm Patients

Kriegsmann

Pavel

Bochtler

et al. 2020

Transfus Med Hemother

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Introduction: Recently, we identified a huge discrepancy between the collection practice and the actual utilization of cryopreserved peripheral blood stem cells (PBSCs) for high-dose chemotherapy (HDCT) and autologous blood stem cell transplantation (ABSCT). Specifically, patients with Burkitt lymphoma, acute leukemia, and myeloproliferative neoplasms (MPN) were frequently not referred for ABSCT after successful PBSC collection. Objective: The aim of this study was to identify variables that are associated with the non-utilization of PBSC grafts. Methods: We retrospectively analyzed the collection, storage, and disposal of PBSC grafts in Burkitt lymphoma (n = 18), acute lymphoblastic leukemia (ALL, n = 22), MPN (n = 18), and acute myeloid leukemia (AML, n = 71) patients. Patients who underwent autologous PBSC collection at 2 collection and transplantation centers between 2001 and 2012 were included and followed up until 2016. Results: None of the Burkitt lymphoma patients were referred for ABSCT. Only in 1 (6%) patient, the graft was discarded after the patient’s death. In all other patients (n = 17, 94%), the grafts were stored independently of the patient’s status (death, n = 4, 22%; no follow-up, n = 6, 33%; no indication for ABSCT given, n = 7, 39%). In ALL patients, 4 (18%) patients underwent ABSCT after a median follow-up of 74 (1–182) months. In the remaining patients, PBSC grafts were either discarded (8 patients, 36%) or stored until the reference date (10 patients, 45%). Seven of 18 MPN patients (39%) underwent ABSCT. ABSCT was performed in 24 (34%) AML patients. In 20 (28%) patients who were not referred to ABSCT, an allogeneic transplantation (TPL) was performed. Fifteen (21%) patients received palliative care or deceased, and their grafts were discarded in all but 1 patient. Additional grafts were discarded in 21 (31%) patients and stored in 9 (13%) patients who underwent ABSCT or allogeneic TPL (n = 44). Conclusions: As the role and efficacy of autologous HDCT/ABSCT are not established in the analyzed entities, the indication for PBSC collection should be reanalyzed in regular intervals. Moreover, PBSC grafts from patients who have deceased, have insufficient grafts, or have already undergone an allogeneic TPL should be considered for disposal or (if applicable) for research use, to economize storage costs on a rational basis.

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“…On the other hand, for patients with core-binding-factor AML, i.e., AML with t (8;21); AML with inv (16) or t (16;16); and an NPM1 mutation in absence of an FLT3 mutation or with FLT3 low allelic burden, ELN recommends, after induction, up to four courses of ID/HDARAC, even though it remains unclear whether ID or HDARAC of two or three course would be preferred [15,16]. Numerous studies have demonstrated that ASCT could be offered to younger patients in the favorable and intermediate cytogenetic risk groups with results not inferior to ID/HDARAC in terms of relapse occurrence and survival [17][18][19][20][21][22][23][24][25]. Relapse remains a major cause of treatment failure ASCT, and in most cases it occurs within the first 2 years after transplantation.…”

Section: Post Remission Therapymentioning

confidence: 99%

“…Among these, patients Core-Binding-Factor (CBF) AML and AML with a NMP1 mutation in absence of an FLT3 one are the ideal candidates to receive ASCT [32][33][34]. Notwithstanding, even in this setting, the role of ASCT remains unclear, although most studies that have compared ASCT with intensive consolidation chemotherapy (ICC) demonstrated a significantly lower rate of relapse following ASCT [17][18][19][20][21][22]. However, results in terms of survival were less encouraging because of transplant-related deaths and the low rate of second CR in patients who relapsed after ASCT; therefore, in the last year, ASCT has become less popular both in Europe and the USA.…”

Section: Molecular Geneticsmentioning

confidence: 99%

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

Ferrara

Picardi

2019

Cancers

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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.

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Revisiting autologous transplantation in acute myeloid leukemia

Cited by 11 publications

References 23 publications

Acute myeloid leukemia: 2021 update on risk‐stratification and management

Acute myeloid leukemia: 2021 update on risk‐stratification and management

Cryostorage to What End? – Autologous Stem Cell Products in Burkitt Lymphoma, Acute Lymphoblastic Leukemia, Acute Myeloid Leukemia, and Myeloproliferative Neoplasm Patients

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

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