Alternative donor transplantation in acute myeloid leukemia: which source and when?

Acute myeloid leukemia is a heterogeneous disease with a prognosis determined mostly by the leukemic karyotype. Allogeneic transplant in first remission is offered to patients with intermediate- and poor-risk cytogenetics. Only the minority of patients, however, have a matched sibling donor.

Matched unrelated, genetically haploidentical and umbilical cord blood have been increasingly used. Pros and cons of each procedure are discussed, and whenever available, comparisons are made.

With the progress made in supportive care and prophylaxis of graft-versus-host disease, significant improvement in results of transplant from alternative donors has enabled its increasing use in specific disease stages. The recommended transplant for a given patient and the timing of transplant are discussed.