Treatment of Acute Myeloid Leukemia With Hematopoietic Stem Cell Transplantation

Cortney V. Jones; Edward A. Copelan

Disclosures

Future Oncol. 2009;5(4):559-568. 

In This Article

Future of Transplantation for AML

Despite repeated past predictions that better nontransplant approaches would eliminate the need for transplantation in most patients, its use in AML has increased and results have steadily improved with time. Transplantation remains underutilized,[83] and is too often delayed beyond its optimal timing. The United States General Accounting Office estimated that only a third of patients needing transplants from unrelated donors even had searches requested by the National Marrow Donor Registry.[84] Improved identification of closely matched unrelated donors, modifications of myeloablative preparation and reduced intensity regimens now make transplantation safely available to more patients. Better differential prognostic factors more reliably identify patients in first remission who should be treated with transplantation. High-resolution genomic techniques can identify previously unrecognized relevant genetic lesions,[85] which will further assist in selection of patients for transplantation. The genetic polymorphisms of interleukin-10[86] and other cytokines,[87] as well as other proteins[88] that influence GVHD, have been identified. Genotyping promises to help identify donors, estimate risk and individualize GVHD prevention.[83] The natural killer cell alloreactive mechanism involving killer-cell immunoglobin-like receptors can reduce relapse rates in AML. Better understanding of this system may also aid in donor selection and improve results.[89] While many investigators are understandably excited by recent progress in the identification of leukemic stem cells[90] and drugs,[91] and antibodies[92] that target them, transplantation provides a means to rescue patients from agents that may eliminate normal hematopoietic stem cells as well as their malignant counterparts. Transplantation appears destined to provide the most effective curative therapy for many patients with AML in the foreseeable future.

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