Hematopoietic cell transplantation in first complete remission versus early relapse

Although data from a number of clinical trials can help guide the choice, the decision of whether patients with acute myeloid leukemia (AML) should undergo transplantation while in first remission or should have transplantation withheld until relapse is a particularly difficult one. Current data suggest that patients with AML and unfavorable cytogenetics should undergo allogeneic transplantation while in first remission if at all possible. Patients with AML and good risk cytogenetics can probably forgo transplantation until after first relapse. For patients with intermediate risk disease, the decision of transplantation during first remission versus waiting until first relapse is particularly difficult and should be made only after considering additional individual risk factors. If the decision is made to delay transplantation until first relapse, there are additional steps that physicians should take to ensure that salvage transplantation is possible, including identifying the source of hematopoietic stem cells in advance of relapse and developing a careful monitoring plan for the patient while in first remission.