Prevention and Treatment of Acute Myeloid Leukemia Relapse after Hematopoietic Stem Cell Transplantation: The State of the Art and Future Perspectives.
Salvatore LeottaAnnalisa CondorelliRoberta SciortinoGiulio Antonio MiloneClaudia BellofioreBruno GaribaldiGiovanni SchininĂ Andrea SpadaroAlessandra CupriGiuseppe MilonePublished in: Journal of clinical medicine (2022)
Allogeneic hematopoietic stem cell transplantation (HSCT) for high-risk acute myeloid leukemia (AML) represents the only curative option. Progress has been made in the last two decades in the pre-transplant induction therapies, supportive care, selection of donors and conditioning regimens that allowed to extend the HSCT to a larger number of patients, including those aged over 65 years and/or lacking an HLA-identical donor. Furthermore, improvements in the prophylaxis of the graft-versus-host disease and of infection have dramatically reduced transplant-related mortality. The relapse of AML remains the major reason for transplant failure affecting almost 40-50% of the patients. From 10 to 15 years ago to date, treatment options for AML relapsing after HSCT were limited to conventional cytotoxic chemotherapy and donor leukocyte infusions (DLI). Nowadays, novel agents and targeted therapies have enriched the therapeutic landscape. Moreover, very recently, the therapeutic landscape has been enriched by manipulated cellular products (CAR-T, CAR-CIK, CAR-NK). In light of these new perspectives, careful monitoring of minimal-residual disease (MRD) and prompt application of pre-emptive strategies in the post-transplant setting have become imperative. Herein, we review the current state of the art on monitoring, prevention and treatment of relapse of AML after HSCT with particular attention on novel agents and future directions.
Keyphrases
- acute myeloid leukemia
- allogeneic hematopoietic stem cell transplantation
- end stage renal disease
- prognostic factors
- ejection fraction
- newly diagnosed
- chronic kidney disease
- acute lymphoblastic leukemia
- multiple sclerosis
- rheumatoid arthritis
- cardiovascular events
- free survival
- type diabetes
- squamous cell carcinoma
- coronary artery disease
- systemic lupus erythematosus
- disease activity
- risk factors
- health insurance
- patient reported
- chronic pain
- patient reported outcomes
- smoking cessation