Autologous stem cell transplantation for adult acute leukemia in 2015: time to rethink? Present status and future prospects.
The use of autologous stem cell transplantation (ASCT) as consolidation therapy for adult patients with acute leukemia has declined over time. However, multiple randomized studies in the past have reported lower relapse rates after autologous transplantation compared with chemotherapy and lower non-relapse mortality rates compared with allogeneic transplantation. In addition, quality of life of long-term survivors is better after autologous transplantation than after allogeneic transplantation. Further, recent developments may improve outcomes of autograft recipients. These include the use of IV busulfan and the busulfan+melphalan combination, better detection of minimal residual disease (MRD) with molecular biology techniques, the introduction of targeted therapies and post-transplant maintenance therapy. Therefore, ASCT may nowadays be reconsidered for consolidation in the following patients if and when they reach a MRD-negative status: good- and at least intermediate-1 risk acute myelocytic leukemia in first CR, acute promyelocytic leukemia in second CR, Ph-positive acute lymphocytic leukemia. Conversely, patients with MRD-positive status or high-risk leukemia should not be considered for consolidation with ASCT.
Department of Hematology and Cell Therapy and EBMT, Hôpital Saint-Antoine APHP, INSERM U 938, Université Pierre et Marie Curie UPMC, Paris, France.
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Gorin
Department of Bone Marrow Transplantation, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland.
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Giebel
Department of Hematology and Cell Therapy and EBMT office, Hôpital Saint-Antoine APHP, INSERM U 938, Université Pierre et Marie Curie UPMC, Paris, France.
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Labopin
Vanderbilt University Medical Center, Nashville, TN, USA.
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Savani
Department of Hematology and Cell Therapy and EBMT office, Hôpital Saint-Antoine APHP, INSERM U 938, Université Pierre et Marie Curie UPMC, Paris, France.
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Mohty
Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Nagler
D000328:Adult; D064592:Autografts; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000401:mortality / Q000628:therapy*; D018365:Neoplasm, Residual; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D033581:Stem Cell Transplantation / Q000379:methods* / Q000639:trends