Alternative donor transplantation in acute myeloid leukemia: which source and when?

Abstract

Purpose of review: Acute myeloid leukemia is a heterogeneous disease with a prognosis determined mostly by the leukemic karyotype. Allogeneic transplant in first remission is offered to patients with intermediate- and poor-risk cytogenetics. Only the minority of patients, however, have a matched sibling donor.

Recent findings: Matched unrelated, genetically haploidentical and umbilical cord blood have been increasingly used. Pros and cons of each procedure are discussed, and whenever available, comparisons are made.

Summary: With the progress made in supportive care and prophylaxis of graft-versus-host disease, significant improvement in results of transplant from alternative donors has enabled its increasing use in specific disease stages. The recommended transplant for a given patient and the timing of transplant are discussed.