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Allogene Transplantation in der Behandlung der akuten Leukämien

Allogeneic transplantation in the treatment of acute leukemia

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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Die allogene Stammzelltransplantation (SZT) in der Therapie akuter Leukämien ist eine evolutionäre Therapie und hat in den letzten Jahren an Bedeutung zugenommen.

Methode

Es handelt sich um eine Übersicht über die Indikationen der allogenen SZT bei akuten Leukämien.

Ergebnisse

Bei HLA-identem Familien- oder HLA-kompatiblem Fremdspender ist die allogene SZT bei Patienten mit akuter myeloischer Leukämie (AML) mit intermediärem Risiko eine Standardtherapieoption als Postremissionstherapie, bei Patienten mit hohem Risiko die bisher einzige Option mit kurativem Therapieziel. Mit Verbesserungen in der Supportivtherapie sowie der Etablierung dosisreduzierter Konditionierungsregime und zunehmender Spenderverfügbarkeit gilt diese Indikationsstellung auch für ältere Patienten, die ohne allogene SZT eine ungünstige Prognose haben. Die allogene SZT ist bisher die einzige kurative Therapie für Patienten mit primär refraktärer Erkrankung oder Rezidiv. Patienten mit akuter lymphatischer Leukämie (ALL), die prognostisch in die Hoch- oder Höchstrisikogruppe eingeordnet werden, sollte ebenfalls eine allogene SZT in 1. Remission empfohlen werden. Bei Standardrisiko-ALL-Patienten ist die Indikationsstellung vom Verlauf der minimalen Resterkrankung abhängig.

Schlussfolgerung

Die Entscheidung zur allogenen SZT wird für jeden Patienten individuell gestellt und ist abhängig vom Risikoprofil der Leukämie, von der Verfügbarkeit eines geeigneten Spenders, von den Begleiterkrankungen und nicht zuletzt vom Wunsch des aufgeklärten Patienten.

Abstract

Background

Allogeneic hematopoietic stem cell transplantation (HSCT) is an evolutionary treatment modality for acute leukemia that has gained importance during the past decade.

Methods

This article reviews the indications for HSCT.

Results

For intermediate-risk acute myeloid leukemia (AML) patients with a performance status allowing transplantation and an available HLA-identical familial or HLA-compatible unrelated donor, allogeneic HSCT is a standard post-remission treatment option; for high-risk patients, it is currently still the only therapeutic option with curative intent. Due to improvements in supportive therapy, establishment of reduced-intensity conditioning regimens, and increasing donor availability, allogeneic HSCT can also be considered in elderly AML patients with an otherwise poor prognosis. Allogeneic HSCT is currently the only curative treatment option in cases of refractory or relapsed leukemia. For high- or highest-risk acute lymphoblastic leukemia (ALL) patients, allogeneic HSCT should be recommended in the first complete remission. The indication for allogeneic HSCT for standard-risk ALL patients depends on the course of minimal residual disease.

Conclusion

The decision to perform allogeneic HSCT depends mainly on the leukemia risk profile, donor availability, preexisting comorbidities, and last but not least, on the individual preferences of a well-informed patient.

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Authors and Affiliations

  1. Medizinische Klinik A/KMT-Zentrum, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A12, 48149, Münster, Deutschland

    Eva Schmidt, Jan-Henrik Mikesch, Christoph Groth, Christoph Schliemann, Georg Lenz, Wolfgang E. Berdel &  Matthias Stelljes

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  1. Eva Schmidt
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  2. Jan-Henrik Mikesch
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  3. Christoph Groth
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  4. Christoph Schliemann
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  6. Wolfgang E. Berdel
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  7. Matthias Stelljes
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Correspondence to Matthias Stelljes.

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Interessenkonflikt

E. Schmidt, J.-H. Mikesch, C. Groth, C. Schliemann, G. Lenz, W.E. Berdel und M. Stelljes geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Schmidt, E., Mikesch, JH., Groth, C. et al. Allogene Transplantation in der Behandlung der akuten Leukämien. Onkologe 23, 543–549 (2017). https://doi.org/10.1007/s00761-017-0234-6

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