3-5 On the basis of specific structural and numerical cytogenetic abnormalities, patients with AML are divided into favorable, intermediate-, or adverse-risk groups. Cytogenetics is the most robust prognostic marker for risk stratification of AML at the time of diagnosis as well as in selection of postremission treatments. Progress in the last 2 decades in understanding the disease biology of AML may guide further practice changes. Graft source on all adult AML patients, % 2ĪML patients undergoing allo-HCT, all ages The guidelines of various major organizations in Europe and the United States on the use of HCT for AML patients are not consistent. Despite these trends, there remains wide variation in the application of HCT in AML patients, especially during CR1. Among URDs, umbilical cord blood (UCB) is becoming an important graft source in adults and contributed to 11% of adult transplants from URDs in 2008 ( Table 1). CIBMTR data demonstrate that 47% of CR1 allografts (all ages) in AML in 2008 were performed with the use of URDs. The growth of transplant activity is mainly in adults and is attributable to increased use of URDs, especially in first remission (CR1 Table 1, Figure 1). Although the number of transplants from related donors has remained stable during the last decade, transplants from unrelated donors (URDs) are growing ( Table 1). Data from Center for International Blood and Marrow Transplant Research (CIBMTR) indicate a sustained increase in the number of AML allogeneic transplants in the last decade ( Table 1). 1 Currently, AML is the most common indication for HCT. The curative effect of HCT in patients with AML is contributed both by the chemotherapy and/or radiation in the preparative regimen and more importantly by the immunologic graft-versus-leukemia (GVL) effect. Continued study of HCT versus alternative therapies is required to optimize patients' outcomes in AML.Īllogeneic hematopoietic cell transplantation (HCT) is a curative treatment option for patients with acute myeloid leukemia (AML). ![]() ![]() The use of reduced-intensity conditioning has expanded the eligibility of HCT to older patients with AML, and outcome data are encouraging. Increasing data demonstrate outcomes of alternative donor transplantation approaching HLA-identical sibling donors in high-risk AML supporting the inclusion of alternative donors in trials of prospective studies evaluating post remission strategies for high-risk AML. In this review, the positioning of HCT in the management of patients with AML is evaluated in view of changing risk/benefit ratios associated with both conventional treatments and transplantation, and some of the controversies are addressed in light of emerging data. In parallel, several important advances in the transplant field, such as better supportive care, improved transplant technology, increased availability of alternative donors, and reduced-intensity conditioning have improved the safety as well as access of allogeneic hematopoietic cell transplantation (HCT) for a larger number of patients. ![]() Molecular markers in combinations with cytogenetics have improved the risk stratification of acute myeloid leukemia (AML) and informed decision-making. ![]() Progress in the last decade has improved the understanding of leukemia biology.
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