Incorporating hematopoietic cell transplantation (HCT) into the management of adults aged under 60 years with acute myeloid leukemia (AML)

Current strategies for incorporating hematopoietic cell transplantation into the treatment of adults with AML are based predominantly on pre-treatment patient, donor and disease characteristics. These strategies, while useful, have significant shortcomings in that they recommend deferred transplantation for many patients who would benefit from earlier intervention and, at the same time, direct other patients who would be cured with chemotherapy alone to the more risky and toxic approach of early transplantation. Here we review the currently accepted indications for transplantation and raise the possibility that alternative approaches to incorporating transplantation into the management of adults with AML that rely predominantly on the measurement of minimal residual disease (MRD) could save additional lives without any major advance in chemotherapy or transplant technologies.

Key words: hematopoietic cell transplantation, acute myeloid leukemia, minimal residual disease, chemotherapy, PCR-based assays, multicolor flow cytometry