Role of Allogeneic Stem Cell Transplantation in Current Treatment of Acute Myeloid Leukemia

Allogeneic hematopoietic stem cell transplantation (alloSCT) has been established as an effective consolidation therapy in acute myeloid leukemia (AML) in first or subsequent remission. Although it effectively prevents relapse, treatment-related mortality (TRM) associated with alloSCT may compro-mise that beneficial effect. As a result, alloSCT may be restricted to patients with a relatively high risk of relapse. Here, we review studies that identify catego-ries of AML patients who may specifically benefit from alloSCT. In addition, we discuss recent developments with respect to alternative donors, stem cell sources, and supportive care. Finally, we highlight recent results obtained with reduced-intensity alloSCT, which already significantly influence our therapeutic strat-egy in elderly patients with AML. During the last three decades allogeneic hematopoietic stem cell transplantation (alloSCT) has become an established therapeutic modality in patients with acute myeloid leuke-mia (AML). The alloreactive immunotherapeutic effects against the leukemia (graft-versus-leukemia reactivity) contribute greatly to its efficacy. No other established therapy applied during complete remission offers as strong an anti-leukemic effect. Unfortunately, the benefit of alloSCT is considerably offset by the complications fol-lowing transplantation. These complications, which are related to disparity of host-recipient histocompatibility and the toxicity of high-dose chemotherapy and radiotherapy, ask a considerable price in terms of morbidity and mortal-ity. As a result, alloSCT produces only a limited gain in overall survival despite significantly reducing relapse.1-6 Key issues in the current clinical use of alloSCT in th