Acute myeloid leukemia: when to transplant in first complete remission

Allogeneic hematopoietic stem cell transplantation (HSCT) is commonly used to treat acute myeloid leukemia (AML) because it is potentially curative when other therapies have a low likelihood of success. Although most patients with newly diagnosed AML will achieve a first complete remission (CR1) with standard induction chemotherapy, obtaining a durable remission necessarily requires either further (postremission) chemotherapy or allogeneic HSCT. The decision of which of these options to choose is complex and depends on both clinical and molecular variables as well as the availability and histocompatibility of donor stem cells. Important clinical factors include the individual patient's age, performance status, and comorbidities. Molecular and cytogenetic factors are increasingly important in stratifying patients into favorable, intermediate, and unfavorable risk categories. Whereas patients with favorable-risk cytogenetics fare better with postremission chemotherapy, allogeneic HSCT provides superior long-term survival for most non-elderly patients with intermediate-risk or unfavorable-risk AML. Because of the expanded use of umbilical cord blood as a source of hematopoietic stem cells and the use of reduced-intensity conditioning regimens, allogeneic HSCT is an option for an increasing number of patients with AML.