[Allogeneic hematopoietic stem cell transplant for acute myeloid leukemia]

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a key curative option in the treatment of acute myeloid leukemia (AML), and its indication should be carefully determined on the basis of prognostic factors and treatment response. Recent advances in genetic profiling and measurable residual disease (MRD) monitoring using RT-qPCR or flow cytometry have significantly influenced decisions on transplant timing and necessity. This review outlines current transplant indications according to the ELN risk classification, strategies for patients not in remission, the clinical utility of MRD assessment, and recent developments in post-transplant maintenance and relapse treatment, while also taking into account current practices and perspectives in Japan. Rather than relying on fixed criteria, transplant strategies should be tailored through an integrated evaluation of disease biology, MRD status, age, comorbidities, and overall patient fitness. This individualized approach helps optimize patient outcomes in the evolving treatment landscape of AML. Ongoing reassessment of transplant eligibility is needed to reflect current evidence and clinical realities.