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Hematopoietic stem cell transplantation for acute myeloid leukemia

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Abstract

Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) yields a high rate of curability for acute myeloid leukemia (AML), it is also associated with transplant-related morbidity and mortality (TRM). The risk and severity of TRM increase with the use of an alternative donor graft in the absence of an HLA-matched sibling donor (MSD). With the declining birthrate and aging of the population, the numbers of patients with an MSD are decreasing, and alternative donor transplants, including the post-transplant cyclophosphamide method using haplo-identical donors, are increasing. Autologous (auto)-HSCT, which enables the intensification of chemotherapy, has the advantage of high availability of a transplant graft, and is associated with a lower TRM, but these benefits may be offset by a higher rate of relapse due to the lack of a graft-versus-leukemia (GVL) effect. Although allo-HSCT remains the first-line treatment for poor and very-poor-risk patients, auto-HSCT is again gaining increased attention. It has also recently been suggested that cord blood grafts may induce a stronger GVL effect than other grafts; as such, the positioning of cord blood transplantation should also be reconsidered for AML patients.

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Acknowledgements

This study was supported by grants from the Ministry of Health, Labour and Welfare of Japan, and the Ministry of Education, Culture, Sports and Technology of Japan. The grant sources played no role in the study design, data collection and analysis, the decision to publish or the preparation of the manuscript.

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  1. Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, 480-1195, Japan

    Akiyoshi Takami

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Takami, A. Hematopoietic stem cell transplantation for acute myeloid leukemia. Int J Hematol 107, 513–518 (2018). https://doi.org/10.1007/s12185-018-2412-8

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