Role of allogeneic and autologous hematopoietic stem cell transplantation in acute myeloid leukemia.
Most younger patients with acute myeloid leukemia will enter remission of disease. Prevention of relapse is now the central therapeutic issue. A number of factors predict the risk of relapse, the most powerful of which is cytogenetics. Both allogeneic and autologous transplantation have been extensively used as remission consolidation, but intensive chemotherapy has also provided improved results such that the choice of consolidation treatment is not clear. Recent prospective trials of allogeneic and autologous transplantation with careful analysis have not always shown a survival benefit, although both approaches have significantly reduced relapse risk. In analysis where relapse risk is taken into account based on cytogenetics, there is little evidence of the benefit of transplantation in good-risk patients, partly because patients in this group who relapse can then undergo successful salvage therapy. The results are still uncertain in standard-risk patients, so transplantation should continue to be used in the context of a trial. Poor-risk patients have a higher failure rate after transplantation, and for these patients novel approaches are required.
Burnett
A K
AK
Department of Hematology, University of Wales College of Medicine, Cardiff Wales, United Kingdom. edwardssa1@cardiff.ac.uk
Kell
J
J
Rowntree
C
C
D000208:Acute Disease; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007951:Leukemia, Myeloid / Q000473:pathology / Q000628:therapy*; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous