Current status of blood and marrow transplantation for patients with AML

During the past decade it has become apparent that patients can be transplanted successfully after preparation with regimens of reduced intensity. Reduced intensity preparations have resulted in lower morbidity and mortality during the pre-engraftment period, but have not reduced later occurring infections, GVHD and relapse. Outcome-determining risk factors that characterize patients at diagnosis as well as during their course include age, cytogenetic configuration, hematopoietic elements and a previous history of myelodysplasia or cytoreductive therapy for a pre-existing malignancy. These factors are complemented by the response to induction therapy and subsequent treatments as well as by the duration of the response. More recently, gene expression profiling of leukemic cells has added a new dimension to simultaneously assessed biological risk factors that may ultimately lead to individuation of therapy.