The who, how and why: Allogeneic transplant for acute myeloid leukemia in patients older than 60 years

Abstract

Acute myelogenous leukemia (AML) is primarily a disease of the elderly, and as such, our approach to treatment needs to be tailored to address an aging population. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only potentially curative treatment for intermediate and high risk AML, and until recently, its use had been limited to a younger population and dependent on availability of a donor. Advances in conditioning regimens, supportive care, and the use of alternative donor sources have greatly expanded access to this therapy. In this review, we summarize the challenges and unique biological aspects of treatment with allogeneic stem cell transplantation in this group of patients older than 60 years. We also highlight areas of ongoing research including measurement of residual disease prior to and following transplant, post-remission maintenance therapy, and natural killer cell immunotherapy. Finally, we propose future directions for AML treatment in an elderly and aging population.

Targeted in-vitro-stimulation reveals highly proliferative multi-virus-specific human central memory T cells as candidates for prophylactic T cell therapy

“…For several advanced hematologic malignancies, especially AML, alloHSCT can be the only curative treatment option and despite persisting high mortality rates number of applications rise continuously [1,51–53]. Recently–due to the introduction of reduced intensity conditioning (RIC) regimes [54,55]–the indication for alloHSCT has been further expanded towards elderly patients reflecting the epidemiologic need for a disease that is diagnosed at a median age of 65 years [56,57]. At the same time, elderly patients are especially susceptible for (chronic) GVHD and infection, together representing major causes for alloHSCT-related mortality in this patient group.…”

Socioeconomic and health system factors associated with lower utilization of hematopoietic cell transplantation in older patients with acute myeloid leukemia

“…Additionally, a scarcity of high-quality comparative trials demonstrating the value of HCT in older patients may limit the enthusiasm of many oncologists to utilize HCT in older patients. In more recent years, however, studies have clearly demonstrated the feasibility of and exciting results with reduced intensity and non-myeloablative HCT in select older patients including those above the age of 70 years [4,[6][7][8][9][10][11][12][13] (reviewed by Wall et al [14]). A recent analysis from the Center for International Blood and Marrow Transplant Research demonstrated the safety of HCT specifically in patients older than 70 years; survival had increased over the past decade [13].…”

Epigenetic‐based therapy in allogenic hematopoietic stem cell transplantation: Novel opportunities for personalized treatment

“…Allo-HSCT is the unique effective treatment for high-risk AML patients older than 60 years; however, the prognosis is still poor. 34 The "epigenetic clock" system was used to study the aging dynamics of donor cells after allo-HSCT. 35 The long-term follow-up of the study would evaluate a potential correlation with the GVHD onset.…”