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

Technical Aspects of Transplantation

Traditionally, patients are prepared for transplantation with intensive preparatory therapy. The two most widely used regimens consist of cyclophosphamide and large doses of fractionated TBI,[1,2,15] or busulfan and cyclophosphamide.[16,17,18,19] These regimens effectively eliminate nearly all normal and malignant marrow cells and produce sufficient immunosuppression to prevent rejection of allogeneic hematopoietic cells. Selective radiation of leukemia using radiolabeled monoclonal antibodies against antigens on marrow cells promise to improve results by targeting malignant cells and causing less organ damage.[20] Dose adjustment of busulfan based on plasma levels[18] and intravenous, rather than oral, busulfan also appear to lower toxicity.[19] Although fresh bone marrow, procured in the operating room from the anesthetized donor's iliac crests, had been the standard source of hematopoietic stem cells, granulocyte colony-stimulating factor mobilized peripheral blood stem cells are now also commonly used. Mobilized blood cells engraft more rapidly, but are associated with a higher incidence of chronic GVHD,[21] probably related to larger numbers of T cells. Despite drug regimens to prevent GVHD, which are given for several months after transplant, nearly a third of patients will die from GVHD or regimen-related complications. The risk of mortality varies greatly depending on the general health of the patient, the underlying disease and stage, and the source and histocompatibility of donor cells. In healthy, young patients in remission, who have HLA-identical sibling donors, transplant-related mortality may be less than 20%.

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