title: Reduced intensity conditioning allogeneic hematopoietic cell transplantation for adult acute myeloid leukemia in complete remission - a review from the Acute Leukemia Working Party of the EBMT.
abstract: Acute myeloid leukemia is the most common indication for an allogeneic hematopoietic cell transplant. The introduction of reduced intensity conditioning has expanded the recipient pool for transplantation, which has importantly made transplant an option for the more commonly affected older age groups. Reduced intensity conditioning allogeneic transplantation is currently the standard of care for patients with intermediate or high-risk acute myeloid leukemia and is now most often employed in older patients and those with medical comorbidities. Despite being curative for a significant proportion of patients, post-transplant relapse remains a challenge in the reduced intensity conditioning setting. Herein we discuss the studies that demonstrate the feasibility of reduced intensity conditioning allogeneic transplants, compare the outcomes of reduced intensity conditioning versus chemotherapy and conventional myeloablative conditioning regimens, describe the optimal donor and stem cell source, and consider the impact of post-remission consolidation, comorbidities, center experience, and more intensive (reduced toxicity conditioning) regimens on outcomes. Additionally, we discuss the need for further prospective studies to optimize transplant outcomes.
authors.affiliation: Section of Hematology and Stem Cell Transplant, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Salyka
authors.initials: S
authors.lastname: Sengsayadeth
authors.affiliation: Section of Hematology and Stem Cell Transplant, Vanderbilt University Medical Center, Nashville, TN, USA Acute Leukemia Working Party of the EBMT, Marseille, France.
authors.forename: Bipin N
authors.initials: BN
authors.lastname: Savani
authors.affiliation: Programme de Transplantation & Therapie Cellulaire - Centre de Recherche en Cancérologie de Marseille - Institut Paoli Calmettes, Marseille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
authors.affiliation: Department of Haematology, Saint Antoine Hospital, Paris, France INSERM UMR 938, Paris, France Université Pierre et Marie Curie, Paris, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Malard
authors.affiliation: Acute Leukemia Working Party of the EBMT, Marseille, France Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel EBMT Paris Study Office/CEREST-TC, Paris, France.
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
authors.affiliation: Department of Haematology, Saint Antoine Hospital, Paris, France INSERM UMR 938, Paris, France Université Pierre et Marie Curie, Paris, France EBMT Paris Study Office/CEREST-TC, Paris, France mohamad.mohty@inserm.fr.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D002986:Clinical Trials as Topic; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D012074:Remission Induction; D016019:Survival Analysis; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D019653:Myeloablative Agonists