Transplantation Beyond First Remission & in Refractory Patients
In patients who receive post-remission chemotherapy on the basis of prognostic factors or patient/physician choice, it is essential to anticipate management of potential relapse. HLA typing of siblings to identify family donors and, in their absence, preliminary search for unrelated donors will permit appropriate planning. If relapse is identified early with less than 30% marrow blasts, it is reasonable to proceed with allogeneic transplantation without prior chemotherapy if the procedure can be arranged quickly. Obtaining cells from unrelated adult donors is usually too slow to permit this, but occasionally can be accomplished. When transplantation is performed in early relapse, more patients (approximately 30%) become 3-year leukemia-free survivors[61,62] than after a second attempt at induction therapy.
Outside of first complete remission and relapse/second complete remission, sustained survival occurs in less than 20% of patients.[63,64,65,66,67,68,69] Too often, patients who would have enjoyed favorable prognoses with transplantation early in the course of the disease undergo transplantation 'too late', when results are much less favorable. Still, in many patients with advanced disease, allotransplantation represents their only chance for cure and is often justified. Patients with disease refractory to chemotherapy,[64,65] with large numbers of blasts in marrow and/or blood, and with serious infections or other comorbidities, have a particularly high risk of transplant-related mortality and low chance for cure. Careful analysis of important prognostic variables can identify patients in whom transplantation is not justified because the chance of cure is minimal.
Future Oncol. 2009;5(4):559-568. © 2009 Future Medicine Ltd.
Cite this: Treatment of Acute Myeloid Leukemia With Hematopoietic Stem Cell Transplantation - Medscape - May 01, 2009.