Autologous Hematopoietic Stem Cell Transplantation in Acute Myelogenous Leukemia

Abstract

The clinical outcomes of autologous hematopoietic stem cell transplantation (ASCT) in acute myelogenous leukemia (AML) have improved over time. Indeed, numerous studies have demonstrated that ASCT is associated with a lower relapse rate and acceptable nonrelapse mortality compared with chemotherapy alone in patients with AML. In addition, ASCT is also associated with comparable overall survival outcomes to those of allogeneic hematopoietic stem cell transplantation in some patients with AML. To date, age, cytogenetic and molecular risk stratification, and minimal residual disease (MRD) status have been shown to be closely related to clinical outcomes following ASCT. ASCT is recommended for patients with favorable-risk and intermediate-risk AML in first complete remission and patients with acute promyelocytic leukemia in second complete remission for whom a matched sibling donor is not available. MRD status pre-ASCT is the most important factor to consider when determining whether a patient is eligible for ASCT and can effectively predict clinical outcomes after ASCT. Advanced age is not an absolute contradiction for ASCT. In this review, we describe the literature and clinical trials evaluating the outcomes of ASCT in patients with AML and discuss the indications for ASCT therapy. Because the greatest concern in ASCT recipients is early relapse, important factors that should be monitored before ASCT and future perspectives in this area are also presented.

Characterisation of canine CD34+/CD45 diminished cells by colony-forming unit assay and transcriptome analysis

“…In fact, HSCT is performed by autologous and allogeneic methods, both of which generally use PBSCs collected by apheresis. Autologous transplantation has the advantage of avoiding graft-vs.-host disease (GvHD), and it has a reduced relapse risk (RR) over allogeneic transplantation ( 54 ). Even though allogeneic transplantation has an increased GvHD risk in some recipients, it has been widely used to attack and eradicate malignant cells, in which the donor immune cells are capable of eradicating chemotherapy-resistant tumour cells by the graft-versus-tumour (GVT) effect ( 55 ).…”

Fate of hematopoietic stem cells determined by Notch1 signaling (Review)

“…For example, the clinical efficacy of auto-HSCT for AML has gradually improved. A group of European researchers retrospectively analyzed the survival outcomes of 809 patients with AML in their first complete response and identified that the 2-year leukemia-free survival rate and overall survival rate were 51 and 65%, respectively, and the non-recurrence mortality rate was only 3.7% ( 115 ). Taking it a step further, Passweg ( 116 ) revealed that the 3-year overall survival rate of AML was 34 ( 21-56 )% following chemotherapy, but 75 ( 60-95 )% following consolidation with auto-HSCT.…”

“…Taking it a step further, Passweg ( 116 ) revealed that the 3-year overall survival rate of AML was 34 ( 21-56 )% following chemotherapy, but 75 ( 60-95 )% following consolidation with auto-HSCT. In fact, a large number of studies have revealed that auto-HSCT is associated with lower recurrence rates and an acceptable non-recurrent mortality rate in AML patients compared with chemotherapy alone ( 115 ). In addition, in certain AML patients, auto-HSCT was comparable to allo-HSCT in overall survival ( 116 ).…”

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

“…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.…”

“…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.…”