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Review
. 2020 Jan;188(1):129-146.
doi: 10.1111/bjh.16355. Epub 2019 Dec 10.

The role of allogeneic stem cell transplantation in the management of acute myeloid leukaemia: a triumph of hope and experience

Justin Loke  1   2 , Ram Malladi  1   2 , Paul Moss  1   2 , Charles Craddock  1   2
Affiliations
Review

The role of allogeneic stem cell transplantation in the management of acute myeloid leukaemia: a triumph of hope and experience

Justin Loke et al. Br J Haematol. 2020 Jan.

Abstract

Acute myeloid leukaemia (AML) is the commonest indication for allogeneic stem cell transplantation (allo-SCT) worldwide. The accumulated experience of allografting in AML over the last four decades has provided critical insights into both the contribution of the conditioning regimen and the graft-versus-leukaemia effect to the curative potential of the most common form of immunotherapy utilised in standard clinical practice. Coupled with advances in donor availability and transplant technologies, this has resulted in allo-SCT becoming an important treatment modality for the majority of adults with high-risk AML. At the same time, advances in genomic classification, coupled with progress in the accurate quantification of measurable residual disease, have increased the precision with which allo-mandatory patients can be identified, whilst simultaneously permitting accurate identification of those patients who can be spared the toxicity of an allograft. Despite this progress, disease recurrence still remains a major cause of transplant failure and AML has served as a paradigm for the development of strategies to reduce the risk of relapse - notably the novel concept of post-transplant maintenance, utilising pharmacological or cellular therapies.

Keywords: acute myeloid leukaemia; allogeneic stem cell transplantation; graft-versus-host disease; graft-versus-leukaemia.

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Figures

Figure 1
Figure 1
Representation of mechanisms determining immune recognition of acute myeloid leukaemia tumour cells by NK and T cells (A) at the time of disease presentation, (B) during a graft‐versus‐leukaemia response and (C) at the time of disease relapse after transplant.
Figure 2
Figure 2
Measurable residual disease measurement methods in acute myeloid leukaemia.
Figure 3
Figure 3
Strategies to reduce the risk of disease relapse in patients allografted for acute myeloid leukaemia.
Figure 4
Figure 4
Post‐transplant maintenance strategies to reduce relapse risk in patients allografted for acute myeloid leukaemia. (A) Pharmacological acceleration of a graft‐versus‐leukaemia (GVL) effect; (B) pharmacological manipulation of the kinetics of disease relapse to ‘buy’ time for the genesis of a GVL effect.
Figure 5
Figure 5
Management of relapse postallogeneic stem cell transplantation in acute myeloid leukaemia, including immune modulation and chemotherapy strategies.
See this image and copyright information in PMC

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