Abstract
After intensive induction chemotherapy and complete remission achievement, patients with acute myeloid leukemia (AML) are candidates to receive either high-dose cytarabine-based regimens, or autologous (ASCT) or allogeneic (allo-SCT) hematopoietic stem cell transplantations as consolidation treatment. Pretreatment risk classification represents a determinant key of type and intensity of post-remission therapy. Current evidence indicates that allo-SCT represents the treatment of choice for high and intermediate risk patients if clinically eligible, and its use is favored by increasing availability of unrelated or haploidentical donors. On the contrary, the adoption of ASCT is progressively declining, although numerous studies indicate that in favorable risk AML the relapse rate is lower after ASCT than chemotherapy. In addition, the burden of supportive therapy and hospitalization favors ASCT. In this review, we summarize current indications (if any) to ASCT on the basis of molecular genetics at diagnosis and minimal residual disease evaluation after induction/consolidation phase. Finally, we critically discuss the role of ASCT in older patients with AML and acute promyelocytic leukemia.
Highlights
Acute myeloid leukemia (AML) is a complex, genetically heterogeneous disease of hematopoietic stem cells (HSCs), characterized by multiple somatically acquired driver mutations, co-existing competing clones and disease evolution over time [1,2,3]
Genetic abnormalities are powerful prognostic factors in both young and elderly patients with AML [8,9], and the European leukemia Net (ELN) panel have proposed a widely adopted classification system with three risk groups, which is especially valuable for the selection of post complete remission therapy [10]
Post complete remission (CR) treatment of AML includes in all eligible patients, one consolidation course, based on high/intermediate dose of cytarabine (HDARAC/IDARAC), followed by two or three cycles of similar chemotherapy; alternative options include autologous stem cell transplantation (ASCT) and allogeneic SCT [13]
Summary
Acute myeloid leukemia (AML) is a complex, genetically heterogeneous disease of hematopoietic stem cells (HSCs), characterized by multiple somatically acquired driver mutations, co-existing competing clones and disease evolution over time [1,2,3]. The accumulation of genetic changes results in the disruption of normal mechanisms of HSC self-renewal, proliferation and differentiation, and leads to the accumulation of immature cells (myeloblast) in the bone marrow and peripheral blood. The advent of high-throughput new molecular techniques has provided new insights into the molecular basis of the disease, so that different genetic profiles at diagnosis can definitely influence the therapeutic strategy either at front-line or after relapse [4,5,6,7]. Genetic abnormalities are powerful prognostic factors in both young and elderly patients with AML [8,9], and the European leukemia Net (ELN) panel have proposed a widely adopted classification system with three risk groups (favorable, intermediate and adverse), which is especially valuable for the selection of post complete remission (post CR) therapy [10]
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