Acute Myeloid Leukemia in Young Adults: Does Everyone Need a Transplant?

Abstract

With the exception of the minority of patients with acute myelocytic leukemia who are considered potentially cured by chemotherapy, hematopoietic cell transplantation (HCT) has traditionally been the recommended approach for those patients achieving complete remission who meet the criteria for HCT and have an appropriate stem-cell donor. This decision has become more complex with the discovery of new risk factors, such as genomic abnormalities and minimal residual disease, especially in younger populations. Patients younger than age 60 years who are considered fit and who do not harbor poor prognostic features are felt still to have a high likelihood of cure without having to undergo HCT. Here, we discuss the role that these emerging risk factors play in the decision to undergo transplantation, but emphasize that this remains a decision made jointly by the patient, the treating hematologist, and the transplant physician.

Lymphocyte Exhaustion in AML Patients and Impacts of HMA/Venetoclax or Intensive Chemotherapy on Their Biology

“…In the US, the median age at diagnosis is 68 years, with 10–15% 5-year survival for patients >60 years and 30–35% for younger patients [ 2 ]. About 80% of younger patients can achieve complete response (CR) with timely treatment [ 3 ], but most will eventually relapse without allogeneic hematopoietic stem cell transplantation (allo-HSCT) [ 3 , 4 ].…”

Allogeneic Hematopoietic Cell Transplantation in Younger Patients With Acute Myeloid Leukemia

“…In the article that accompanies this commentary, Roberts et al 1 discuss the role of allogeneic hematopoietic cell transplantation in reducing the risk of relapse in younger adults with acute myeloid leukemia (AML). The use of cytarabine-anthracycline combination for induction followed by postremission highdose cytarabine consolidation achieves long-term disease control in only a proportion of patients.…”

“…In the past 2 years, eight new drugs have been approved for the treatment of AML, and several other drugs are undergoing phase III trials. 7 As Roberts et al 1 indicate, these drugs so far have not changed whether a young patient will undergo allotransplantation. However, liposomal cytarabine and daunorubicin (CPX 351), compared with 713, demonstrated a significantly lower risk of post-transplantation mortality in an exploratory analysis.…”