Improving allogeneic hematopoietic stem cell transplantation in the setting of acute myeloid leukemia : refining risk stratification

Allogeneic stem cell transplantation (allo-SCT) remains to date the best therapeutic strategy in high-risk acute myeloid leukemia (AML). However, the benefit of allo-SCT may vary between cytogenetic subgroups. How can allo-SCT really improve outcomes of bad AML such as complex karyotype, monosomal karyotype, -5/5q-, -7/7q-, 17p abnormalities and/or inv(3)? And if we found a limited benefit of allo-SCT in some very high-risk AML, the role of allo-SCT in selected patients with good-risk AML should be revisited. Despite major improvements in supportive care, patients’ age and conditioning intensity remain important factors to be integrated in the decision-making to bring a patient to allo-SCT. Relapse is still the major cause of treatment failure after allo-SCT, and survival of such patients is dismal. New therapeutic strategies to prevent or treat relapse after allo-SCT should be explored in the next future.(MED - Sciences médicales) -- UCL, 201