The role of allogeneic transplantation in high-risk acute myelogenous leukemia

Abstract

Patients with high-risk acute myelogenous leukemia (AML) in first remission are at increased risk for disease recurrence and are often considered for allogeneic bone marrow transplantation (BMT) if there is a suitable HLA-identical sibling donor. Analysis of results from randomized clinical trials comparing different treatment strategies for patients with AML (chemotherapy, autologous BMT, and allogeneic BMT) suggests that allogeneic BMT may be a superior treatment modality for patients in the high-risk subgroup. Interpretation of clinical trial results, however, is problematic due to poor compliance with transplant options, absence of studies specifically designed to addresses this question, and ongoing redefinition of the highrisk subgroup. Alternative allogeneic transplant approaches to reduce toxicity from graft-versus-host disease and enhance graft-versus-leukemia reactivity may offer therapeutic promise in this patient population.

Long-term results in children with AML: NOPHO-AML Study Group – report of three consecutive trials

“…Thus, it may be prudent to use more restrictive indications for SCT in first remission, reserving this procedure for poor risk and relapsed patients. 4,20,21 The 5-year EFS of 48%, DFS of 52% and OS of 65% in the NOPHO-AML 93 compares favourably with other AML studies. CCG-2891 showed DFS of 55% and survival of 63% in the intensive-timing group.…”

“…This is in contrast to results from other groups. 16,20 The OS of 68% in NOPHO-AML 93 in patients not transplanted in CR-1 is comparable to the best results in patients receiving SCT. 16 The good OS in the chemotherapy group is explained by a good result in relapsed patients treated with SCT in CR-2.…”

The role of reduced intensity conditioning allogeneic stem cell transplantation in patients with acute myeloid leukemia: a donor vs no donor comparison

“…In our study, only 71% of patients with a matched sibling donor actually received the RIC-allo-SCT, in accordance with previous data from the myeloablative allo-SCT setting. 23,24 However, it should be noted that only two patients (6%) could not proceed for RIC-allo-SCT because of early relapse. The latter might reflect the fact that 485% of the patients from this series received some form of high-dose chemotherapy (high-dose cytarabine and/or autologous transplantation) prior to allo-SCT.…”

Elevated serum insulin-like growth factor binding protein-2 is associated with a high relapse risk after hematopoietic stem cell transplantation in childhood AML

“…It offers the opportunity for a better survival prediction for high-risk patients. 21 It is well accepted that the leukemic relapse after HSCT is associated with the disease level prior to transplantation as well as the minimal residual disease status after transplantation. 22,23 New reports suggest a correlation between an increased number of minimal residual leukemic cells in bone marrow and the probability of relapse.…”