Autologous stem cell transplantation for adult acute leukemia
in 2015: time to rethink? Present status and future prospects
N-C Gorin1, S Giebel2, M Labopin3, BN Savani4, M Mohty5 and A Nagler6
The use of autologous stem cell transplantation (ASCT) as consolidation therapy for adult patients with acute leukemia has declined
over time. However, multiple randomized studies in the past have reported lower relapse rates after autologous transplantation
compared with chemotherapy and lower non-relapse mortality rates compared with allogeneic transplantation. In addition, quality
of life of long-term survivors is better after autologous transplantation than after allogeneic transplantation. Further, recent
developments may improve outcomes of autograft recipients. These include the use of IV busulfan and the busulfan+melphalan
combination, better detection of minimal residual disease (MRD) with molecular biology techniques, the introduction of targeted
therapies and post-transplant maintenance therapy. Therefore, ASCT may nowadays be reconsidered for consolidation in the
following patients if and when they reach a MRD-negative status: good- and at least intermediate-1 risk acute myelocytic leukemia
in first CR, acute promyelocytic leukemia in second CR, Ph-positive acute lymphocytic leukemia. Conversely, patients with MRDpositive
status or high-risk leukemia should not be considered for consolidation with ASCT.
Bone Marrow Transplantation (2015) 50, 1495–1502; doi:10.1038/bmt.2015.179; published online 17 August 2015 (read more in the attachment)
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