What is the role of a second allogeneic hematopoietic cell transplant in relapsed acute myeloid leukemia?

Relapsed acute myeloid leukemia (AML) after an allogeneic hematopoietic cell transplant (allo-HCT) entails a poor prognosis. Treating these cases is challenging due to lack of effective therapies and, in some cases, poor performance status and/or presence of graft-versus-host disease (GVHD), among o...

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Bibliographic Details
Published in:Bone marrow transplantation (Basingstoke) 2020-02, Vol.55 (2), p.325-331
Main Authors: Moukalled, Nour M., Kharfan-Dabaja, Mohamed A.
Format: Article
Language:English
Subjects:
631/67/1990/283/1897
692/699/1541/1990/283/1897
Acute myeloid leukemia
Cell Biology
Clinical trials
Disease control
Diseases
Graft-versus-host reaction
Hematology
Hematopoietic stem cells
Internal Medicine
Leukemia
Medicine
Medicine & Public Health
Mortality
Mutation
Myeloid leukemia
Patients
Population studies
Public Health
Relapse
Remission
Review Article
Risk factors
Stem cell transplantation
Stem Cells
Transplantation
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Summary:Relapsed acute myeloid leukemia (AML) after an allogeneic hematopoietic cell transplant (allo-HCT) entails a poor prognosis. Treating these cases is challenging due to lack of effective therapies and, in some cases, poor performance status and/or presence of graft-versus-host disease (GVHD), among others. No randomized controlled trial (RCT) has ever been conducted comparing a second allo-HCT against other treatments. Existing data are mainly from observational studies or registries. Success of a second allo-HCT is dependent on appropriately selecting patients who might achieve best outcomes with reasonable non-relapse mortality (NRM) risk. Several factors are associated with worse outcomes, namely a shorter time from first allo-HCT to relapse or to the second allo-HCT, and AML not being in complete hematologic remission (CR). Patients relapsing earlier than 6 months or having active/persistent disease should be enrolled in clinical trials. Limitations of the published literature include retrospective small size studies, a heterogeneous population, and absence of information on somatic mutations, among others. Future studies assessing the role of a second allo-HCT should evaluate the impact of IDH1, IDH2 , or others on outcomes; and the feasibility and efficacy of targeted therapies in the pre-, peri-, or post-second allo-HCT setting.
ISSN:0268-3369
1476-5365
DOI:10.1038/s41409-019-0584-3