Alternative donor transplants for high-risk acute myeloid leukemia

Allogeneic stem cell transplantation is a potentially curative treatment for some high-risk patients with acute myeloid leukemia, but wider use of this treatment is limited by donor availability. Although use of alternative donors in these patients is increasing, the role of alternative donors in these high-risk patients, especially in first remission, remains undefined.

Results of recent studies indicate that the outcomes with unrelated donors matched at allele levels (10/10) are similar to those in human leukocyte antigen identical sibling donor transplant recipients. Encouraging results have been reported in older patients with acute myeloid leukemia with the use of unrelated donors, extending the benefit of allografting to a wider patient population. Cord blood transplantation and haploidentical transplants are alternative options when a suitable unrelated donor is not available in a timely manner. Disease status at the time of transplantation appears to be a major determinant of outcome with any of these options because outcomes remain dismal for patients with active leukemia at transplantation.

Encouraging data from current studies indicate that the use of alternative donors in high-risk acute myeloid leukemia patients in first remission deserves prospective evaluation. This option should be included in future clinical trial designs.