PMID: 15217552Jun 26, 2004Paper

Stem cell transplantation in acute myelogenous leukemia in first remission: what are the options?

Current Hematology Reports
Vikram Mathews, John F DiPersio

Abstract

Most newly diagnosed patients with acute myeloid leukemia (AML) in first remission will relapse without additional consolidation therapy. The options for consolidation therapy include repeated cycles of high-dose cytosine arabinoside-based chemotherapy and autologous or allogeneic stem cell transplantation (SCT). Chemotherapy alone is associated with the highest risk of relapse, but it has the lowest treatment-related mortality (TRM). Allogeneic SCT has the lowest risk of relapse with the highest TRM, whereas autologous SCT has an intermediate risk of relapse and TRM. Cytogenetic status of patients with AML is the single most important prognostic factor. However, it is increasingly recognized that this factor alone is inadequate for risk stratification. Based on cytogenetic stratification, a good-risk group of patients in first complete remission (CR1) would benefit most from high-dose consolidation chemotherapy. The risks of a SCT outweigh the benefit in this group. In the unfavorable-risk group, an allogeneic sibling SCT in CR1 would be acceptable, whereas the outcomes with chemotherapy alone or with an autologous SCT are dismal. Based on minimal data, a matched-unrelated donor SCT for this group of patients should be recomme...Continue Reading

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