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World J Stem Cells. Apr 26, 2014; 6(2): 69-81
Published online Apr 26, 2014. doi: 10.4252/wjsc.v6.i2.69
Allogeneic hematopoietic cell transplant for acute myeloid leukemia: Current state in 2013 and future directions
Abraham S Kanate, Marcelo C Pasquini, Parameswaran N Hari, Mehdi Hamadani
Abraham S Kanate, Osborn Hematopoietic Malignancy and Transplantation program, Section of Hematology/Oncology, West Virginia University, Morgantown, WV 26506, United States
Marcelo C Pasquini, Parameswaran N Hari, Mehdi Hamadani, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Author contributions: All the authors contributed equally to this manuscript.
Correspondence to: Mehdi Hamadani, MD, Associate Professor of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, United States. mhamadani@mcw.edu
Telephone: +1-414-8050643 Fax: +1-414-8050643
Received: November 12, 2013
Revised: January 12, 2014
Accepted: March 13, 2014
Published online: April 26, 2014
Abstract

Acute myeloid leukemia (AML) represents a heterogeneous group of high-grade myeloid neoplasms of the elderly with variable outcomes. Though remission-induction is an important first step in the management of AML, additional treatment strategies are essential to ensure long-term disease-free survival. Recent pivotal advances in understanding the genetics and molecular biology of AML have allowed for a risk-adapted approach in its management based on relapse-risk. Allogeneic hematopoietic cell transplantation (allo-HCT) represents an effective therapeutic strategy in AML providing the possibility of cure with potent graft-versus-leukemia reactions, with a demonstrable survival advantage in younger patients with intermediate- or poor-risk cytogenetics. Herein we review the published data regarding the role of allo-HCT in adults with AML. We searched MEDLINE/PubMed and EMBASE/Ovid. In addition, we searched reference lists of relevant articles, conference proceedings and ongoing trial databases. We discuss the role of allo-HCT in AML patients stratified by cytogenetic- and molecular-risk in first complete remission, as well as allo-HCT as an option in relapsed/refractory AML. Besides the conventional sibling and unrelated donor allografts, we review the available data and recent advances for alternative donor sources such as haploidentical grafts and umbilical cord blood. We also discuss conditioning regimens, including reduced intensity conditioning which has broadened the applicability of allo-HCT. Finally we explore recent advances and future possibilities and directions of allo-HCT in AML. Practical therapeutic recommendations have been made where possible based on available data and expert opinion.

Keywords: Acute myeloid leukemia, Allogeneic hematopoietic cell transplantation, Reduced intensity conditioning, Myeloablative conditioning, Haploidentical, Umbilical cord blood

Core tip: Acute myeloid leukemia (AML) represents a heterogeneous group of high-grade myeloid neoplasms of the elderly with variable outcomes. We discuss the role of allo-hematopoietic cell transplantation (HCT) in AML patients stratified by cytogenetic- and molecular-risk in first complete remission, as well as allo-HCT as an option in relapsed/refractory AML.