To transplant or not to transplant for adult acute myeloid leukemia: an ever-evolving decision

In 2007, a group of experts charged by the American Society for Blood and Marrow Transplantation critically reviewed the available literature and summarized the indications for allogeneic hematopoietic cell transplantation versus chemotherapy in adults with acute myeloid leukemia. Much of the resulting position statement was based on studies conducted nearly 2 decades ago, and may not accurately represent current treatment. As a result of advances in both therapeutic regimens and supportive care, a number of recent studies have demonstrated clear and consistent improvements in the outcomes of patients receiving chemotherapy and allogeneic hematopoietic cell transplantation. In addition, prognostic accuracy has improved with the identification of mutations not detected by traditional cytogenetics. With these advancements in prognostic accuracy and treatment, it is now appropriate to revisit the indications for transplantation versus chemotherapy.