Blood and Marrow Transplant Program, Princess Margaret Hospital, University of Toronto, 610 University Ave., Toronto, Ontario, Canada.
Blood. 2011 Feb 24;117(8):2307-18. doi: 10.1182/blood-2010-10-265603. Epub 2010 Nov 22.
Progress in the last decade has improved the understanding of leukemia biology. Molecular markers in combinations with cytogenetics have improved the risk stratification of acute myeloid leukemia (AML) and informed decision-making. In parallel, several important advances in the transplant field, such as better supportive care, improved transplant technology, increased availability of alternative donors, and reduced-intensity conditioning have improved the safety as well as access of allogeneic hematopoietic cell transplantation (HCT) for a larger number of patients. In this review, the positioning of HCT in the management of patients with AML is evaluated in view of changing risk/benefit ratios associated with both conventional treatments and transplantation, and some of the controversies are addressed in light of emerging data. Increasing data demonstrate outcomes of alternative donor transplantation approaching HLA-identical sibling donors in high-risk AML supporting the inclusion of alternative donors in trials of prospective studies evaluating post remission strategies for high-risk AML. The use of reduced-intensity conditioning has expanded the eligibility of HCT to older patients with AML, and outcome data are encouraging. Continued study of HCT versus alternative therapies is required to optimize patients' outcomes in AML.
过去十年的进展提高了人们对白血病生物学的理解。分子标志物与细胞遗传学相结合，改善了急性髓细胞白血病 (AML) 的风险分层，并为决策提供了信息。与此同时，移植领域的几项重要进展，如更好的支持性护理、改进的移植技术、更多可供选择的供体以及减轻强度的预处理，提高了异基因造血细胞移植 (HCT) 的安全性和更多患者的可及性。在这篇综述中，根据与传统治疗和移植相关的风险/获益比的变化，评估了 HCT 在 AML 患者管理中的定位，并根据新出现的数据探讨了一些争议。越来越多的数据表明，在高危 AML 中，替代供体移植的结果接近 HLA 完全匹配的同胞供体，支持在前瞻性研究中纳入替代供体，以评估高危 AML 缓解后策略。减轻强度的预处理的使用扩大了 HCT 对年龄较大的 AML 患者的适用性，并且预后数据令人鼓舞。需要继续研究 HCT 与替代疗法，以优化 AML 患者的治疗效果。
