Treatment outcomes and toxicity for autologous and allogeneic hematopoietic cell transplantation (HCT) for consolidation or salvage therapy.
| . | Autologous HCT . | Allo HCT (Sib) . | AlloHCT/MUD . | Reduced-Intensity AlloHCT + MUD . |
|---|---|---|---|---|
| * Because of high salvage rate and long-term sequelae, many would reserve autologous HCT for relapse for patients with favorable cytogenetics. | ||||
| ** Most of these patients represent patients with high grade myelodysplastic syndrome (MDS) in which an unrelated donor search was initiated prior to leukemic evolution. | ||||
| *** DFS interval will be 5 years unless otherwise noted | ||||
| Abbreviations: AML, acute myeloid leukemia; DFS, disease-free survival; TRM, treatment-related mortality; HCT, hematopoietic cell transplantation; MUD, matched unrelated donor; allo, allogeneic; CR, complete response | ||||
| Consolidation(CR1) | ||||
| Cytogenetic risk | ||||
| t(15;17) | No role | No role | No role | No role |
| t(8;21)inv(16) | DFS 60%–80%* TRM 4%–8% | DFS 65% TRM 18% = No Role | No role | No role |
| Intermediate | DFS 42%–55% TRM 4%–6% | DFS 48%–62% TRM 16%–20% | Insufficient data for nonmyeloablative | |
| Poor | DFS 18%–25% TRM 4%–8% | DFS 35%–45% TRM 18%–20% | 5-yr DFS 30%–40% TRM 30% | Reduced intensity DFS 50% for older AML CR1 at 2 yr |
| Salvage | ||||
| CR2 | DFS 30% overall DFS 60%–80% for t(15;17) | DFS 40% | Pediatric 40% Adult 5-yr DFS 30% TRM 30% | 2-yr DFS 40%–50%reduced intensity |
| Relapse | Not an option unless “back-up” product from CR1 available | DFS 20%–30% | Pediatric DFS 20% 10%–15% | 2-yr DFS 10%–30% Adult 5-yr DFS depending on the volume of residual disease |
| Induction Failure | No Role | DFS 30%–40% (3 yrs) (20% for untreated secondary AML) | DFS 20%–30%** | 1-yr DFS 15%–30% (sibling) |
| . | Autologous HCT . | Allo HCT (Sib) . | AlloHCT/MUD . | Reduced-Intensity AlloHCT + MUD . |
|---|---|---|---|---|
| * Because of high salvage rate and long-term sequelae, many would reserve autologous HCT for relapse for patients with favorable cytogenetics. | ||||
| ** Most of these patients represent patients with high grade myelodysplastic syndrome (MDS) in which an unrelated donor search was initiated prior to leukemic evolution. | ||||
| *** DFS interval will be 5 years unless otherwise noted | ||||
| Abbreviations: AML, acute myeloid leukemia; DFS, disease-free survival; TRM, treatment-related mortality; HCT, hematopoietic cell transplantation; MUD, matched unrelated donor; allo, allogeneic; CR, complete response | ||||
| Consolidation(CR1) | ||||
| Cytogenetic risk | ||||
| t(15;17) | No role | No role | No role | No role |
| t(8;21)inv(16) | DFS 60%–80%* TRM 4%–8% | DFS 65% TRM 18% = No Role | No role | No role |
| Intermediate | DFS 42%–55% TRM 4%–6% | DFS 48%–62% TRM 16%–20% | Insufficient data for nonmyeloablative | |
| Poor | DFS 18%–25% TRM 4%–8% | DFS 35%–45% TRM 18%–20% | 5-yr DFS 30%–40% TRM 30% | Reduced intensity DFS 50% for older AML CR1 at 2 yr |
| Salvage | ||||
| CR2 | DFS 30% overall DFS 60%–80% for t(15;17) | DFS 40% | Pediatric 40% Adult 5-yr DFS 30% TRM 30% | 2-yr DFS 40%–50%reduced intensity |
| Relapse | Not an option unless “back-up” product from CR1 available | DFS 20%–30% | Pediatric DFS 20% 10%–15% | 2-yr DFS 10%–30% Adult 5-yr DFS depending on the volume of residual disease |
| Induction Failure | No Role | DFS 30%–40% (3 yrs) (20% for untreated secondary AML) | DFS 20%–30%** | 1-yr DFS 15%–30% (sibling) |