Stem Cell Transplantation

**Chapter 11**

**Abstract**

currently being investigated.

**1. Introduction**

**185**

Stem Cell Transplantation in

*Salvatore Leotta, Annalisa Condorelli, Giovanni Schininà,*

*Roberta Sciortino, Alessandra Cupri and Giuseppe Milone*

Allogeneic hematopoietic stem cell transplantation represents the only potentially curative therapeutic approach for Acute Myeloid Leukemia. The choice to perform an allogeneic hematopoietic transplant is the result of a decision-making process that considers disease-related factors (AML-risk category and the state of disease at the time of transplant), the type of donor available and his characteristics (HLA compatibility, gender, CMV serostatus) and the individual risk associated with the procedure itself. The choice of the appropriate conditioning regimen depends on the patient's age and comorbidities. While the introduction of reduced intensity regimen and the availability of alternative donors allows more patients to be eligible for transplantation, myeloablative conditioning remains the standard of care for fit patients. Disease relapse is the leading cause of treatment failure and new strategies attempting at reducing the relapse incidence post transplantation are

**Keywords:** acute myeloid leukemia, allogeneic stem cell transplantation, treatment-related mortality, donor selection, conditioning regimen

Allogeneic hematopoietic stem cell transplantation (HSCT) represents the only potentially curative therapeutic approach for Acute-Myeloid Leukemias (AML) [1]. This approach is often limited by the patient's transplant-eligibility, which depends on age and comorbidities. Moreover, in patients considered at low risk of relapse, allogeneic transplantation can be offered in case of disease relapse rather than in first complete remission. The high percentage of relapse of leukemia is the leading cause for failure of transplant [2]. The outcome of patients who relapse after transplantation is poor, especially for those who relapse within six months after transplantation for which overall survival at two years is often inferior to 20% [3]. Allogeneic HSCT for AML in first CR is indicated, according to The European Leukemia Network (ELN), when the risk of relapse exceeds 30–40% and the advantage in disease-free survival (DFS) that can derive from it is greater than 10% [4]. The choice to perform an allogeneic hematopoietic transplant is the result of a decision-making process that considers the AML-risk category together with the transplant risk calculated by evaluating both age and comorbidities. In adjunct, the decision-making process comprises the assessment of the disease-status at the moment in which the patient comes to the observation of the transplant-physician.

Acute Myeloid Laeukemia

#### **Chapter 11**
