Is There Still a Role for Autologous Stem Cell Transplantation for the Treatment of Acute Myeloid Leukemia?

Abstract

After intensive induction chemotherapy and complete remission achievement, patients with acute myeloid leukemia (AML) are candidates to receive either high-dose cytarabine-based regimens, or autologous (ASCT) or allogeneic (allo-SCT) hematopoietic stem cell transplantations as consolidation treatment. Pretreatment risk classification represents a determinant key of type and intensity of post-remission therapy. Current evidence indicates that allo-SCT represents the treatment of choice for high and intermediate risk patients if clinically eligible, and its use is favored by increasing availability of unrelated or haploidentical donors. On the contrary, the adoption of ASCT is progressively declining, although numerous studies indicate that in favorable risk AML the relapse rate is lower after ASCT than chemotherapy. In addition, the burden of supportive therapy and hospitalization favors ASCT. In this review, we summarize current indications (if any) to ASCT on the basis of molecular genetics at diagnosis and minimal residual disease evaluation after induction/consolidation phase. Finally, we critically discuss the role of ASCT in older patients with AML and acute promyelocytic leukemia.

Keywords: acute myeloid leukemia; autologous transplantation; minimal residual disease; post-remission therapy.

Figure 1

Declining rates of autologous stem cell transplantation (ASCT) in acute myeloid leukemia (AML) in the USA (panel (A), accessed at www.CIBMTR.org) and Europe (panel (B) [27]).

Figure 2

Annual number of allogeneic hematopoietic stem cell transplantations (allo-SCTs) in patients aged 70 years and older by indication: major increase in AML [30,31].

Figure 3

Comparison of days of neutropenia, thrombocytopenia and hospitalization between ASCT and three courses of a high dose of cytarabine (HDARAC); all differences are statistically significant (p < 0.01).