Department of Hematology, Shaare Zedek Medical Center, Jerusalem.
Department of Hematology and Bone Marrow Transplantation, Rambam Healthcare Campus.
Curr Opin Hematol. 2018 Mar;25(2):95-102. doi: 10.1097/MOH.0000000000000408.
Autologous hematopoietic cell transplantation (auto-HCT) has been evaluated as a consolidation treatment for acute myeloid leukemia (AML) in the 1980s and 1990s. These prospective studies from large trials compared auto-HCT with chemotherapy. A comparison was made also with allogeneic hematopoietic cell transplantation (allo-HCT). These studies reported a lower relapse rate with auto-HCT compared with chemotherapy, but without impact on the overall survival. A high transplant-related mortality in that era confounded the relevance of these data.
Several prospective studies and a plethora of retrospective registry data have confirmed the potent antileukemic therapy of auto-HCT compared with chemotherapy and, in some instances, have even challenged the presumed superiority of allo-HCT as the definitive therapy for certain patients with AML.
The aggregate of recent data, prospective and retrospective, strongly suggests an important role for auto-HCT, at least as the most potent nonimmunologic antileukemia therapy. The transplant-related mortality in 2017 is close to that expected from standard consolidation therapy leading to the conclusion that the role of auto-HCT needs to be rigorously revisited, preferably in prospective studies, to establish its precise role in the current era.
自体造血细胞移植（auto-HCT）自 20 世纪 80 年代和 90 年代以来，已被评估为急性髓系白血病（AML）的巩固治疗方法。这些来自大型试验的前瞻性研究将 auto-HCT 与化疗进行了比较。还与异基因造血细胞移植（allo-HCT）进行了比较。这些研究报告称，与化疗相比，auto-HCT 的复发率较低，但对总生存率没有影响。该时代高的移植相关死亡率使这些数据的相关性受到质疑。
几项前瞻性研究和大量回顾性登记数据证实了与化疗相比，auto-HCT 具有强大的抗白血病作用，并且在某些情况下，甚至对 allo-HCT 作为某些 AML 患者的确定性治疗的假定优势提出了挑战。
最近的前瞻性和回顾性数据汇总强烈表明，auto-HCT 至少作为最强的非免疫性抗白血病治疗具有重要作用。2017 年的移植相关死亡率接近标准巩固治疗所预期的死亡率，得出的结论是，需要严格重新审视 auto-HCT 的作用，最好在前瞻性研究中，以确定其在当前时代的确切作用。
