Hematopoietic Cell Transplantation in Acute Myeloid Leukemia

This chapter discusses issues that arise when considering stem cell transplantation (SCT) for acute myeloid leukemia (AML) patients. Cytogenetics at diagnosis is the most important prognostic factor, and aggressive consolidation strategies such as allogeneic SCT (allo-SCT) in first remission (CR1) in high-risk cytogenetic patients are beneficial. Age should not be an absolute contraindication to proceed with allo-SCT when pursuing a curative approach. It is important to consider performance status and comorbid conditions, rather than age alone, when evaluating transplant candidates. Multiple retrospective series have shown that survival was significantly improved when allogeneic transplantation was compared to nontransplant alternatives such as high-dose cytarabine and targeted therapy. There is no consensus on the optimal management of AML relapse following transplant, and outcomes for patients who relapse following allo-SCT are dismal.