title: A critical review of which children with acute myeloid leukaemia need stem cell procedures.
abstract: The last decades have seen parallel improvements in chemotherapy-based and haematopoietic stem cell transplantation (HSCT) regimens for acute myeloid leukaemia (AML) in children. There has been no consensus on indication for HSCT. Reserving HSCT for high-risk and relapsed patients spare many patients from the long-term toxicity of this treatment. The results of matched unrelated donor HSCT equal family donor transplantation and the presence of a matched sibling should no longer be a transplant indication. Minimal residual disease measured by flow cytometry may identify poor responders benefitting from HSCT in first complete remission (CR1) and those with a favourable response to induction therapy who do not need HSCT even with adverse cytogenetic aberrations. FLT3-internal tandem duplication without NPM1 mutation has a very high relapse rate despite favourable response and HSCT is indicated in CR1 in these cases. Finding the optimal indications for HSCT is a delicate balance between risk of relapse and late effects.
authors.affiliation: Department of Paediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Hasle
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D002648:Child; D002869:Chromosome Aberrations; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000235:genetics / Q000628:therapy*; D018365:Neoplasm, Residual; D000090243:Nucleophosmin; D018579:Patient Selection; D011379:Prognosis; D014019:Tissue Donors
chemical_list: D000970:Antineoplastic Agents; C000716967:NPM1 protein, human; D000090243:Nucleophosmin
keywords: acute myeloid leukaemia; chemotherapy; children; haematopoietic stem cell transplantation; late-effects