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Allogene Stammzelltransplantation bei akuten Leukämien

Allogeneic stem cell transplantation for acute leukemia

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Die Onkologie Aims and scope

Zusammenfassung

Hintergrund

Das Therapiespektrum der akuten Leukämien erweitert sich in Primär- und Salvagetherapie durch neue, v. a. zielgerichtete Therapien. Die allogene Stammzelltransplantation (SZT) ist eine wesentliche Therapieoption für über die Hälfte der Patient*innen und entwickelt sich v. a. in den Bereichen der Konditionierung und immunmodulatorischer Therapien zur Prävention und Therapie von Komplikationen weiter. Diese Fortschritte führten zur signifikanten Verbesserung der Therapieergebnisse.

Methode

Auf Literaturrecherche basiert wird die Indikationsstellung der allogenen SZT bei akuter myeloischer (AML) und lymphatischer Leukämie (ALL) zusammengefasst.

Ergebnisse

Die Einteilung in biologisch definierte Risikogruppen zu Therapiebeginn und das Therapieansprechen mit Bestimmung der messbaren Resterkrankung sind wichtige Parameter zur Indikationsstellung der allogenen SZT bei akuten Leukämien. Bei der ALL ist das Erreichen einer Remission vor Transplantation entscheidend, bei aktiver rezidivierter/refraktärer AML konnte die allogene SZT als Therapieoption etabliert werden. Dosisreduzierte und remissionsadaptierte Konditionierungen, optimierte Strategien der Spenderidentifikation sowie verbesserte Therapieoptionen zur Kontrolle infektiologischer und immunologischer Komplikationen führten zu verbesserter Lebensqualität und Prognose von Patient*innen nach allogener SZT.

Schlussfolgerung

Die erfolgreiche Therapie von akuten Leukämien basiert auf präziser Risikostratifizierung bei Diagnose, einer patienten- und krankheitsadaptierten Induktionstherapie sowie sorgfältiger Selektion der Postremissions- oder Salvagetherapie. Auch im Zeitalter antigenspezifischer Zelltherapien bleibt die allogene SZT wichtiger Bestandteil von Konzepten der Postinduktionsphase.

Abstract

Background

New, mainly targeted therapies are expanding treatment options for acute leukemias, especially for induction and salvage therapy. However, allogeneic stem cell transplantation (SCT) is a consolidation or salvage treatment for more than half of the patients diagnosed with acute leukaemia and advances are reported, especially in the areas of conditioning and immunomodulatory therapies for prevention and treatment of complications. These advances have led to significant improvement in treatment outcomes.

Methods

Based on a literature search, indications for allogeneic SCT in acute myeloid (AML) and lymphoblastic (ALL) leukemia are summarized.

Results

Classification of acute leukemia into biologically defined risk groups at the beginning of therapy and the degree of response to therapy including measurable residual disease are important indicators for allogeneic SCT. In ALL, molecular remission before SCT is crucial, and allogeneic SCT is a treatment option in patients with relapsed/refractory AML. Reduced intensity and remission-adapted conditioning, optimized donor identification strategies and new treatment options to control infectious and immunological complications have contributed to improved quality of life and prognosis for patients after allogeneic SCT.

Conclusion

Successful treatment of acute leukemia is based on precise risk stratification at diagnosis, induction therapy adapted to the specific risk factors of the patient and the disease, and prudent selection of postremission or salvage therapy. Even in the era of antigen-specific cellular therapies, allogeneic SCT remains an important part of postinduction therapy concepts.

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Authors and Affiliations

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

    Christian Reicherts

  2. Klinik für Strahlentherapie, Universitätsklinikum Münster, Münster, Deutschland

    Michael Oertel

  3. Klinik für Hämatologie, Onkologie, Stammzelltransplantation, Universitätsklinikum Essen, Essen, Deutschland

    Christina Rautenberg

Authors
  1. Christian Reicherts
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  2. Michael Oertel
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  3. Christina Rautenberg
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Correspondence to Christian Reicherts.

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Interessenkonflikt

C. Reicherts, M. Oertel und C. Rautenberg geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Reicherts, C., Oertel, M. & Rautenberg, C. Allogene Stammzelltransplantation bei akuten Leukämien. Onkologie 28, 504–510 (2022). https://doi.org/10.1007/s00761-022-01166-z

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