The role of allogeneic stem cell transplantation in the management of acute myeloid leukaemia: a triumph of hope and experience

Abstract

Acute myeloid leukaemia (AML) is the commonest indication for allogeneic stem cell transplantation (allo-SCT) worldwide. The accumulated experience of allografting in AML over the last four decades has provided critical insights into both the contribution of the conditioning regimen and the graft-versus-leukaemia effect to the curative potential of the most common form of immunotherapy utilised in standard clinical practice. Coupled with advances in donor availability and transplant technologies, this has resulted in allo-SCT becoming an important treatment modality for the majority of adults with high-risk AML. At the same time, advances in genomic classification, coupled with progress in the accurate quantification of measurable residual disease, have increased the precision with which allo-mandatory patients can be identified, whilst simultaneously permitting accurate identification of those patients who can be spared the toxicity of an allograft. Despite this progress, disease recurrence still remains a major cause of transplant failure and AML has served as a paradigm for the development of strategies to reduce the risk of relapsenotably the novel concept of post-transplant maintenance, utilising pharmacological or cellular therapies.

Application of machine learning in the management of acute myeloid leukemia: current practice and future prospects

“…These risks include high treatment toxicity, infectious complications, graft-versus-host-disease (GVHD), transplant failure, and relapse. 77 Evaluating suitable patients for transplantation and patients at risk for complications is therefore crucial before starting conditioning therapy. Shouval et al 78 identified key variables to predict overall survival 100 days after transplantation in an analysis of .25 000 leukemia patients from the European Society for Blood and Marrow Transplantation with various ML techniques; they validated the scoring system in a prospective cohort study of 1848 patients from the Italian national transplant network.…”

Cellules humaines à usage thérapeutique : état de la question

“…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] . Elle est aussi indiquée dans les leucémies aiguës lymphoblastiques de l’adulte avec anomalies cytogénétiques défavorables, en cas de phénotype pré-B et chez les patients avec un taux de leucocytes élevés au diagnostic.…”

HLA-DPB1 Reactive T Cell Receptors for Adoptive Immunotherapy in Allogeneic Stem Cell Transplantation

“…In addition, in some patients the GvL effect is not sufficient to eradicate patients' leukemia. Therefore, more effective strategies are needed to treat patients with recurrent disease after alloHSCT [2].…”