Haematologica, Vol 92, Issue 4, 533-541 doi:10.3324/haematol.10867
Copyright © 2007 by Ferrata Storti Foundation
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Acute Myeloid Leukemia

Current status of reduced intensity conditioning allogeneic stem cell transplantation for acute myeloid leukemia

Didier Blaise, Norbert Vey, Catherine Faucher, Mohamad Mohty

Unité de Transplantation et de Thérapie Cellulaire (UTTC), Institut Paoli-Calmettes, Marseille (DB,CF, MM); Université de la Méditerranée, Marseille (DB, MM); INSERM, UMR 599, Marseille (DB, MM); Département d’Hématologie, Institut Paoli-Calmettes, Marseille, France (NV, CF).

Correspondence: Mohamad Mohty, RIC subcommittee of the ALWD of EBMT, Unité de Transplantation et de Thérapie Cellulaire (UTTC), Institut Paoli-Calmettes, 232 Bd. Ste Marguerite, 13273 Marseille Cedex 09, France. E-mail: mohtym{at}marseille.fnclcc.fr

Allogeneic stem cell transplantation (allo-SCT) is the most efficient antileukemic treatment for acute myeloblastic leukemia (AML). However, elderly patients can rarely benefit from standard myeloablative allo-SCT because of an unacceptable rate of procedure-related toxicities. This point is critical when considering AML patients in first complete remission. The development of the so-called reduced-intensity conditioning (RIC) regimens appears to decrease allo-SCT-related toxicities, and has emerged as an attractive modality in AML patients not eligible for standard allo-SCT. Such RIC regimens aim primarily to provide the immune graft-versus-leukemia effect while causing little toxicity. Of note, treatment-related toxicity appears to be lower with RIC regimens as compared to standard myeloablative regimens. Nevertheless, toxicity might represent only one aspect of the problem, since AML encompasses a group of chemosensitive diseases, raising concerns that significant reduction of the intensity of the preparative regimen may have a negative impact on long-term leukemic control. Furthermore, no prospective studies have been reported thus far establishing RIC allo-SCT as the preferred option in AML. Investigators are currently faced with a dilemma on how to optimize the potential role of RIC allo-SCT in AML patients, while delivering minimal myeloablation and maximizing allogeneic immunotherapy. The aim of this review is to analyze the available research evidence in this field.

Key words: allogeneic stem cell transplantation, acute myeloid leukemia, reduced intensity conditioning, GVHD, transplant-related mortality.