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Allogeneic hematopoietic stem cell transplantation for acute leukemia
1Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle 98104, USA.
Seminars in Oncology
|February 1, 1997
Summary
Allogeneic transplantation offers a cure for acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) when induction therapy fails. Early human leukocyte antigen (HLA) typing for patients and family is crucial for timely bone marrow transplants.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Allogeneic transplantation is a curative option for refractory acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL).
- Early human leukocyte antigen (HLA) typing is recommended for patients diagnosed with AML or ALL to facilitate timely transplantation if induction therapy fails.
Purpose of the Study:
- To review the role and outcomes of allogeneic transplantation in AML and ALL.
- To discuss donor selection, including HLA-matched siblings, mismatched family donors, unrelated donors, and umbilical cord blood.
Main Methods:
- Review of current literature and clinical practice regarding allogeneic stem cell transplantation for AML and ALL.
- Comparison of outcomes for different donor types and stem cell sources.
Main Results:
- Transplantation is superior to chemotherapy for AML in second remission.
- For children with ALL in second remission, transplantation is the treatment of choice.
- For adults with relapsed ALL, treatment strategy (reinduction vs. direct transplant) depends on remission duration.
- One-antigen mismatched family transplants have similar outcomes to HLA-identical sibling transplants.
- Transplants from donors mismatched for two or three antigens increase graft-versus-host disease (GVHD) risk.
- Unrelated donor transplant outcomes are improving, approaching matched sibling results.
- Umbilical cord blood transplants show feasibility with higher graft failure but lower GVHD.
Conclusions:
- Allogeneic transplantation is a critical curative therapy for specific patient populations with AML and ALL.
- Donor selection and stem cell source significantly impact transplant outcomes, balancing efficacy with complications like GVHD.