Cord blood transplantation in adults with acute myeloid leukaemia

Allogeneic haematopoietic stem cell transplantation represents a potential life-saving procedure for many patients affected by acute myeloid leukaemia. However, in the past its application has been limited by the availability of a HLA matched sibling. To date, an allogeneic transplant from alternative haematopoietic stem cell sources (volunteer unrelated donor, umbilical cord blood, haploidentical family donor) should be considered for all patients with high-risk disease defined by integration of clinical and biological prognosticators. In this context, following the preliminary, encouraging results, the transplant of unrelated umbilical cord blood has been progressively increased because of its prompt availability and a more permissive HLA incompatibility between donor and recipient. Furthermore, the decreased risk of GVHD, the use of reduced intensity conditionings and the graft of double cord blood units permit to extend cord blood transplant to a higher proportion of adult patients with acute myeloid leukaemia, which is predominantly diagnosed in the elderly age. A multicentric, prospective intention-to-treat study is warranted in order to define which haematopoietic stem cell source represents the best choice for allogeneic transplant in high-risk acute myeloid leukaemia.