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Should persons with acute myeloid leukemia have a transplant in first remission?


Despite more than 40 years of extensive study, it remains uncertain which individuals, if any, with acute myelogenous leukemia (AML) in first remission should receive a blood cell or bone marrow transplant versus post-remission chemotherapy (or both). Nevertheless, there is a recent trend toward recommending more transplants in this setting. We consider four myths underlying this recommendation: (1) only individuals achieving second remission benefit from a transplant; (2) there is no effective therapy for relapse other than an allotransplant; (3) we can accurately predict which individuals with AML in first remission need a transplant; and (4) detection of minimal residual disease in first remission will resolve this controversy. We discuss these misconceptions and suggest approaches to resolve this issue.

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RPG acknowledges support from the NIHR Biomedical Research Centre funding scheme. Drs Elisabeth Paietta and Gary Schiller kindly reviewed the typescript.

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Correspondence to R P Gale.

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RPG is a part-time employee of Celgene Corp. PHW is a speaker for Celgene Corp., Novartis and Janssen. HML is a consultant to Actinium Pharmaceuticals, Inc. and Pluristem Therapeutics, Inc. and a speaker for Celgene Corp. Dr Charles Schiffer claims he recently heard Galen comment on his remedy.

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Gale, R., Wiernik, P. & Lazarus, H. Should persons with acute myeloid leukemia have a transplant in first remission?. Leukemia 28, 1949–1952 (2014).

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