title: Reduced-intensity conditioning allogeneic hematopoietic-cell transplantation for older patients with acute myeloid leukemia.
abstract: Elderly patients (>60 years) with acute myeloid leukemia have a poor prognosis with a chemotherapy-alone approach. Allogeneic hematopoietic-cell transplantation (HCT) can improve overall survival (OS). However, myeloablative regimens can have unacceptably high transplant-related mortality (TRM) in an unselected group of older patients. Reduced-intensity conditioning (RIC) or nonmyeloablative (NMA) conditioning regimens preserve the graft-versus-leukemia effects but reduce TRM. NMA regimens result in minimal cytopenia and may not require stem cell support for restoring hematopoiesis. RIC regimens, intermediate in intensity between NMA and myeloablative regimens, can cause prolonged myelosuppresion and usually require stem cell support. A few retrospective and prospective studies suggest a possibility of lower risk of relapse with myeloablative HCT in fit older patients with lower HCT comorbidity index; however, RIC and NMA HCTs have an important role in less-fit patients and those with significant comorbidities because of lower TRM. Whether early tapering of immunosuppression, monitoring of minimal residual disease, and post-transplant maintenance therapy can improve the outcomes of RIC and NMA HCT in elderly patients will require prospective trials.
authors.affiliation: Creighton University Medical Center, 601 North 30th Street, Ste 5850, Omaha, NE 68131, USA.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Goyal
authors.affiliation: University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Krishna
authors.initials: K
authors.lastname: Gundabolu
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Saraschandra
authors.initials: S
authors.lastname: Vallabhajosyula
authors.affiliation: CHI Health Creighton University Medical Center, Omaha, NE, USA.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Silberstein
authors.affiliation: University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Vijaya Raj
authors.initials: VR
authors.lastname: Bhatt
keywords: acute myeloid leukemia; allogeneic hematopoietic-cell transplantation; graft-versus-leukemia effect; myeloablative transplant; nonmyeloablative transplant; older patients; reduced intensity conditioning transplant