title: Should patients with acute myeloid leukemia and measurable residual disease be transplanted in first complete remission?
abstract: Measurable ('minimal') residual disease in acute myeloid leukemia during first complete morphologic remission (MRD CR1) identifies patients with particularly high relapse risk and short survival. Here, we examine the evidence regarding optimal postremission treatment strategy for such patients.
  
  
  
  With chemotherapy alone or chemotherapy/autologous hematopoietic cell transplantation (HCT), disease recurrence appears inevitable in patients with MRD CR1. Nonrandomized studies indicate that allogeneic HCT improves outcomes over chemotherapy and/or autologous HCT, although relapse risks remain substantial. Emerging data suggest that myeloablative cord blood HCT may overcome the negative impact of MRD to a greater degree than other transplants, but the relative contributions of intensified conditioning and stem cell source to this effect are unknown.
  
  
  
  Available evidence supports the recommendation to consider allogeneic HCT for all acute myeloid leukemia patients in MRD CR1. Whether cord blood transplants should be prioritized deserves further investigation. To what degree outcomes of MRD CR1 patients could be improved by treatment intensification during induction, postremission therapy and/or before transplantation to revert the patient into an MRD state is currently unknown, as is the value of post-transplant preemptive therapies. These remain areas worthy of investigation, preferably in the setting of controlled clinical trials.
authors.affiliation: aDepartment of Biomedicine and Prevention, Hematology, University Tor Vergata, Rome, Italy bClinical Research Division, Fred Hutchinson Cancer Research Center cDepartment of Medicine, Division of Hematology dDepartment of Epidemiology, University of Washington, Seattle, Washington, USA.
authors.forename: Francesco
authors.initials: F
authors.lastname: Buccisano
authors.forename: Roland B
authors.initials: RB
authors.lastname: Walter
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000066491:Clinical Decision-Making; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D018365:Neoplasm, Residual / Q000473:pathology*; D011379:Prognosis; D012074:Remission Induction; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome