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The “ultimate” haploidentical transplantation for the elderly with high-risk acute myeloid leukemia

Bone Marrow Transplantation volume 54, pages 803–805 (2019)Cite this article

Acute myeloid leukemia (AML) is the most frequent acute leukemia in adults. The median age at diagnosis is 72 years and its incidence increases by age peaking at 80 years [1]. While the recent employment of new treatments and hematopoietic cell transplantation protocols improved survival of AML patients, outcomes are still poor in the elderly. In fact, the 2-year overall survival is <20% in patients over the age of 60 [2]. The presence of frequent clinically relevant comorbidities that limit standard therapies is not the only reason of such results. The AML in the elderly is characterized by intrinsic biological factors that favor disease resistance, such as the appearance of clones with adverse cytogenetics and a previous diagnosis of myelodysplastic syndrome (MDS). Despite the poor overall survival, a standard intensive chemotherapy can still achieve a complete remission (CR) in about half of the treated patients and even hypomethylating agents can obtain a CR in about 20% of them. These results suggest that the lack of safe and powerful enough consolidative treatments could be responsible for such outcomes of AML in the elderly.

Hematopoietic stem cell transplantation (HSCT) is a curative treatment in patients with AML at high risk of relapse. Because of their potent antileukemic activity, myeloablative conditioning (MAC) regimens are often preferred in AML patients, but their unacceptably high toxicity and subsequent non-relapse mortality limit their use in the elderly. The development of safe and effective reduced-intensity conditioning regimens (RIC) extended the age limit for HSCT to old patients. Rashidi and coworkers [3] recently reported a meta-analysis of 13 eligible studies, with a total sample size of 749 AML elderly patients who received a RIC-matched HSCT. The cumulative incidence of relapse (CIR) at 2 and 3 years was 39% and 39%, respectively. Non-relapse mortality (NRM) was 29 and 40%, respectively. Relapse-free survival (RFS) at 2 and 3 years was 44 and 35%, respectively.

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Funding

Publication of this supplement was sponsored by Gilead Sciences Europe Ltd, Cell Source, Inc., The Chorafas Institute for Scientific Exchange of the Weizmann Institute of Science, Kiadis Pharma, Miltenyi Biotec, Celgene, Centro Servizi Congressuali, and Almog Diagnostic. AP and AV were funded by the Associazione italiana per la Ricerca sul Cancro (AIRC).

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Authors and Affiliations

  1. Hematopoietic Stem Cell Transplantation Program, Division of Hematology and Clinical Immunology, Department of Medicine, University of Perugia, Perugia, Italy

    Antonio Pierini, Loredana Ruggeri, Alessandra Carotti, Franca Falzetti, Sara Piccinelli, Andrea Velardi & Massimo Fabrizio Martelli

  2. Division of Radiotherapy, Department of Sciences and Biomedical Sciences, University of Perugia, Perugia, Italy

    Simonetta Saldi, Valentina Lancellotta & Cynthia Aristei

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  1. Antonio Pierini
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Correspondence to Massimo Fabrizio Martelli.

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Pierini, A., Ruggeri, L., Carotti, A. et al. The “ultimate” haploidentical transplantation for the elderly with high-risk acute myeloid leukemia. Bone Marrow Transplant 54 (Suppl 2), 803–805 (2019). https://doi.org/10.1038/s41409-019-0618-x

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