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Review
. 2021 Aug 19;3(4):153-160.
doi: 10.2991/chi.k.210731.001. eCollection 2021 Dec.

Conditioning Regimens for Frail Patients with Acute Leukemia Undergoing Allogeneic Stem Cell Transplant: How to Strike Gently

Francesco Saraceni  1 , Ilaria Scortechini  1 , Alessandro Fiorentini  1 , Maria Vittoria Dubbini  1 , Giorgia Mancini  1 , Irene Federici  1 , Francesca Romana Colaneri  1 , Antonio Federico Lotito  1 , Selene Guerzoni  1 , Bruna Puglisi  1 , Attilio Olivieri  1
Affiliations
Review

Conditioning Regimens for Frail Patients with Acute Leukemia Undergoing Allogeneic Stem Cell Transplant: How to Strike Gently

Francesco Saraceni et al. Clin Hematol Int. .

Abstract

Despite the recent dramatic progress in acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) therapy, allogeneic transplant remains a mainstay of treatment for patients with acute leukemia. The availability of novel compounds and low intensity chemotherapy regimens made it possible for a significant proportion of elderly and comorbid patients with AML or ALL to undergo curative treatment protocols. In addition, the expansion of donor availability and the recent dramatic progress in haploidentical stem cell transplant, allow the identification of an available donor for nearly every patient. Therefore, an increasing number of transplants are currently performed in elderly and frail patients with AML or ALL. However, allo-Hematopoietic stem cell transplant (HSCT) in this delicate setting represents an important challenge, especially regarding the selection of the conditioning protocol. Ideally, conditioning intensity should be reduced as much as possible; however, in patients with acute leukemia relapse remains the major cause of transplant failure. In this article we present modern tools to assess the patient health status before transplant, review the available data on the outcome of frail AML an ALL patients undergoing allo-HSCT, and discuss how preparatory regimens can be optimized in this setting.

Keywords: Conditioning regimens; acute leukemia; allogeneic stem cell transplant; frail patients.

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Conflict of interest statement

The authors declare they have no conflicts of interest.

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