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Hematopoietic cell transplantation beyond first remission

Leukemia volume 16, pages 157–159 (2002)Cite this article

Introduction Although excellent results have been reported with the use of allogeneic or autologous transplantation for patients with acute myeloid leukemia (AML) in first complete remission (CR), most patients are not transplanted while in first CR. There are a number of reasons for this. Some patients never achieve a first remission. Other patients achieve a first remission and are transplant candidates, but a deliberate decision is made by the physician and/or patient to pursue further chemotherapy and reserve transplantation until relapse. Finally, there are patients who achieve a first remission but, because of age or comorbidities, are not felt to be transplant candidates. In this brief review, all three categories of patients will be considered.

Transplantation for primary induction failure Several studies have shown that long-term survival is possible when allogeneic transplantation is used to treat patients who have failed initial induction chemotherapy. For example, in the experience of the European Bone Marrow Transplant Group, long-term survival was achieved with matched sibling transplantation in 20% of such patients.1 These results emphasize the importance of HLA-typing patients and family members at diagnosis, so that valuable time will not be lost in identifying a suitable source of allogeneic stem cells should remission attempts fail. These results also raise the question of whether we sometimes persist too long in attempting to achieve a complete remission. Is a second cycle of induction worth it for a patient with a matched sibling who has achieved a good partial response with the initial cycle of induction?

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Acknowledgements

This work was supported, in part, by grant number CA-18029 from the National Cancer Institute, National Institutes of Health, DHHS.

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  1. Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine, Seattle, WA, USA

    FR Appelbaum

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This paper is part of a series of keynote addresses to be published in Leukemia. They were presented at the Acute Leukemia Forum, San Francisco, 20 April 2001. Supported by an unrestricted educational grant from Immunex.

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Appelbaum, F. Hematopoietic cell transplantation beyond first remission. Leukemia 16, 157–159 (2002). https://doi.org/10.1038/sj.leu.2402345

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