Acute myeloid leukemia (AML)
Hematopoietic Stem Cell Transplantation
In cases of acute myeloid leukemia, when is hematopoietic stem cell transplantation performed?
Hematopoietic stem cell transplantation (HSCT) is a highly effective treatment that can offer a cure for acute myeloid leukemia (AML), but it's important to consider because it can be very strong. Doctors look at how well a patient might handle intensive chemotherapy, considering their age, health, and how serious the AML is, before deciding if they should go through with HSCT after their initial chemotherapy.
There are two types of HSCT used in AML: autologous, which uses the patient's own cells, and allogeneic, which uses cells from a donor. Autologous HSCT might be the right choice for patients who have a lower risk of AML and have responded well to their first treatments. For patients with a higher risk of AML, or if there's a appropriate donor, doctors often suggest allogeneic HSCT first.
Even though AML is more common in older adults, many used to be unable to have HSCT because it was too intense. Recently, the development of milder forms of chemotherapy before HSCT has made the treatment less intense, which means more older patients can consider it. This careful approach takes into account the seriousness of the AML and the patient's overall health condition.
What are the outcomes of allogeneic hematopoietic stem cell transplantation?
The factors influencing the success of hematopoietic stem cell transplantation in acute myeloid leukemia (AML), such as the classification into risk groups, the age of the patient at the time of the transplant, and achieving complete remission before the transplant, are well-documented. Global statistics from transplant centers reveal that for patients in complete remission, long-term survival rates after transplantation are approximately 50-60% for those in the low-risk group, 30-40% for the intermediate-risk group, and about 20% for those in the high-risk group.
At Catholic Hematology Hospital, the hematopoietic stem cell transplantation outcomes for AML patients in complete remission indicate a 5-year overall survival rate of over 60% for patients in the low-risk group, between 50-60% for the intermediate-risk group, and 30-40% for the high-risk group. These figures are notably higher than the global averages.
On the other hand, AML patients who have not achieved complete remission or who have suffered a relapse face significantly lower survival rates post-transplantation, with long-term survival often reported to be below 10%. Consequently, the necessity for additional treatment modalities and the decision to proceed with stem cell transplantation should be carefully evaluated in consultation with a medical specialist.