Which factor increases the risk of death from allogeneic hematopoietic stem cell transplantation (HCT) for acute myeloid leukemia (AML)?

Updated: May 26, 2020
  • Author: Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Although allogeneic HCT is a potentially curative treatment option for patients with AML, the risk of death increases with age. Fit elderly patients are candidates for reduced-intensity conditioning and nonmyeloablative transplants. [77, 78, 79, 80]  Reduced-intensity and nonmyeloablative regimens feature the use of the purine analog fludarabine and lower doses of alkylating agents or total body irradiation (TBI). Nonmyeloablative regimens may cause only minimal cytopenias that do not require stem cell support, whereas reduced-intensity regimens do require stem cell support.

A study in 190 patients age 60-70 years with AML in first remission reported lower risk of relapse and longer leukemia-free survival with reduced-intensity allogeneic HCT than with induction and postremission chemotherapy using CALGB protocols. At 3 years, risk of relapse was 32% vs 81%, respectively (P < 0.001) and leukemia-free survival was 32% vs 15% (P = 0.001); however, nonrelapse mortality was higher with transplantation (36% vs 4% at 3 years; P <0.001).<ref>82</ref>

For patients 60 years of age or older who have residual disease after standard-dose cytarabine, the National Comprehensive Cancer Network (NCCN) recommends reduced-intensity HCT as an option. Allogeneic HCT is an option for post-remission therapy in patients with a complete response to intensive therapy, preferably in the first remission. Allogeneic HCT, preferably in a clinical trial, can also be considered in patients with induction failure after previous intensive therapy. [25]


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