Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative therapy for adult patients with acute myeloid leukemia (AML), but its use for consolidation therapy after first remission with induction chemotherapy used to be limited to younger patients and those with suitable donors. The median age of AML diagnosis is in the late 60s. With the introduction of reduced-intensity conditioning (RIC), many older adults are now eligible to receive allo-HCT, including those who are medically less fit to receive myeloablative conditioning. Furthermore, AML patients commonly have no human leukocyte antigen (HLA)-identical or medically suitable sibling donor available to proceed with allo-HCT. Technical advances in donor matching, suppression of alloreactivity, and supportive care have made it possible to use alternative donors, such as unrelated umbilical cord blood (UCB) and partially HLA-matched related (haploidentical) donors. Outcomes after alternative donor allo-HCT are now approaching the outcomes observed for conventional allo-HCT with matched related and unrelated donors. Thus, with both UCB and haploidentical donors available, lack of donor should rarely be a limiting factor in offering an allo-HCT to adults with AML.
Highlights
Allogeneic hematopoietic cell transplantation (HCT) is widely used as a curative therapy for acute myeloid leukemia (AML)
AML is more common among the elderly, the time it takes to secure a MUD [1,2] increases the risk of leukemia relapse in this group who need to proceed to HCT promptly
In recent years unrelated umbilical cord blood (UCB) or haploidentical grafts have been studied as alternative donor types for adults with acute leukemia [1,2,3,4,6,7,8,9,10]
Summary
Allogeneic hematopoietic cell transplantation (HCT) is widely used as a curative therapy for acute myeloid leukemia (AML). As the age cutoff for RIC HCT eligibility has increased, there has been a critical need for alternative donors for those who may not have a suitable HLA-matched MSD or MUD donor. In recent years unrelated umbilical cord blood (UCB) or haploidentical grafts have been studied as alternative donor types for adults with acute leukemia [1,2,3,4,6,7,8,9,10]. In this manuscript, we review the outcomes of HCT with these two alternative donor types in the management of adults with AML
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