Actual role of allogeneic haematopoietic transplantation in the treatment of acute myeloid leukaemia

Czech version

Authors: J. Vydra ¹; Z. Ráčil ^1,2; A. Vítek ¹; P. Cetkovský ¹
Authors‘ workplace: Ústav hematologie a krevní transfuze, Praha ¹; Lékařská fakulta Masarykovy Univerzity, Brno ²
Published in: Transfuze Hematol. dnes,26, 2020, No. 4, p. 302-309.
Category: Review/Educational Papers

Overview

Acute myeloid leukaemia is the most common indication for allogeneic hematopoietic cell transplantation. Curative therapy of AML is based on intensive chemotherapy followed by post-remission treatment with chemotherapy alone or with allogeneic hematopoietic cell transplantation. Transplantation is indicated mainly in patients at high risk of relapse, which may be identified using genetic prognostic factors and by monitoring minimal residual disease. Hematopoietic cell transplantation exposes patients to the risk of non-relapse mortality and morbidity, mainly due to graft versus host disease and infections. These risks must be taken into consideration and compared with the potential benefit namely reduction of relapse risk. Conditioning regimen intensity is selected according to patient age and presence of comorbidities. Myeloablative regimens are preferred in all patients who are eligible for full conditioning. Modern myeloablative conditioning regimens based on intravenous busulfan or treosulfan and fludarabine are associated with reduced toxicity and preserved effect on the risk of relapse in comparison to total body irradiation. Reduced intensity and nonmyeloablative conditioning regimens are used in elderly patients and in patients with significant comorbidities. Transplantation may be performed using a graft from HLA identical sibling or unrelated donor, as well as from haploidentical related or partially mismatched unrelated donors. Transplantation from haploidentical related donors using post-transplant high dose cyclophosphamide has dramatically increased the pool of available donors for patients with comparable outcomes to other donor types. The role of allogeneic hematopoietic cell transplantation may be modified in future due to the availability of novel diagnostic and therapeutic modalities.

Keywords:

acute myeloid leukaemia – haematopoietic cell transplantation

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