Therapeutic options for relapsed acute myeloid leukemia after hematopoietic stem cell transplantation

Acute myeloid leukemia (AML) is a malignant clonal hematopoietic cell disorder, characterized by impaired hematopoiesis and bone marrow failure. Allogeneic hematopoietic stem cell transplantation (allo-HCT) is an established therapy with curative potential. Post-transplant relapse does occur and has dismal prognosis, which is the main cause of death after allo-HCT. Relapses after allo-HCT in AML do cause standard treatment approaches challenging, which often necessitate individualized treatment modalities and large prospective clinical trials are needed to delineate standardized therapies. The management of AML relapse after allo-HCT remains a clinical challenge, and no standardized treatment approach currently exists.

This review provides an overview of the available therapeutic options for patients with relapsed AML after allo-HCT. It provides a beneficial framework on the optimal treatment approach, including factors that influence drug preferences. A search of papers published up to March 2025 was conducted on PubMed using the keywords.

Combining chemotherapy, targeted agents, and immunotherapy can increase the rate of response and survival for relapsed AML after allo-HCT. Future research is needed to develop strategies that can reduce the risk of relapse after allo-HCT. Individualization of treatments and exploration of combination therapies are potential approaches for improving efficacy.