Allogeneic hematopoietic stem cell transplantation for the treatment of patients with acute myeloid leukemia. Indications and procedural aspects according to the European study groups

Abstract

transplantation (allo-HSCT) in adults. Meta-analysis of prospective trials based on genetic“donor” vs. “no donor” randomization indicates that only patients with intermediate and highrisk karyotype should be considered for allo-HSCT in first complete remission. Detailed indicationsincluding recommendations for the use of unrelated donors vary among national studygroups. Bone marrow is a preferable source of stem cells. Transplantations of peripheral bloodcells are associated with increased risk of chronic graft versus host disease and thereforeshould be considered mainly for patients with advanced disease and those with high risk ofmortality related to prolonged cytopenia. Myeloablative conditioning based on total body irradiation(TBI) appears favorable compared to oral busulfan in terms of long-term results.Protocols based on intravenous chemotherapy require prospective comparison with TBI. Non--myeloablative conditioning is an option for elderly patients and those with severe co-morbidities.