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Allogeneic Hematopoietic Stem Cell Transplantation for Older Patients With Acute Myeloid Leukemia

  • Leukemia (PH Wiernik, Section Editor)
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Opinion statement

Acute myelogenous leukemia (AML) in the elderly is complex and has a poor prognosis, often characterized by higher risk cytogenetic and molecular features compared to that in younger patients. Rates of transplant have been limited by concern related to non-relapse mortality, as older patients have historically been considered medically unfit for the transplantation process. Reduced-intensity conditioning (RIC) for hematopoietic stem cell transplantation (HSCT) has been shown to provide similar efficacy to myeloablative methods, with decreased non-relapse mortality in the elderly and improved efficacy over non-transplant approaches with cytotoxic chemotherapy alone. Targeted non-cytotoxic and modified cytotoxic agents have emerged to further improve transplant outcomes for older AML patients. Validated comorbidity indices are useful tools to assess an individual’s fitness for undergoing HSCT rather than chronological age alone. We believe HSCT is the primary curative treatment approach for many older AML patients, taking into account risk and comorbidities, particularly given the tendency of leukemia in this population to harbor an unfavorable disease profile. We use RIC and advocate for the addition of targeted agents if applicable. With continuing data in support of transplant for older AML patients, we anticipate that transplant rates in this population will continue to rise.

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  1. Rebecca Levin-Epstein and Caspian Oliai contributed equally to this work.

Authors and Affiliations

  1. UCLA Department of Radiation Oncology, 200 Medical Plaza, Suite B265, Los Angeles, CA, 90095, USA

    Rebecca Levin-Epstein

  2. UCLA Department of Hematology Oncology, 200 Medical Plaza, Suite 120, Los Angeles, CA, 90095, USA

    Caspian Oliai & Gary Schiller

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Rebecca Levin-Epstein declares that she has no conflict of interest. Caspian Oliai declares that he has no conflict of interest. Gary Schiller reports the following outside the submitted work: grants from AbbVie; grants, personal fees, and speakers’ bureau involvement from Agios; grants from Actinium; grants from Ambit; grants, personal fees, and speakers’ bureau involvement from Amgen; grants from Ariad; grants from Array Biopharma; grants and personal fees from Astellas; grants and grant-reviewer activities from Leukemia and Lymphoma Society; grants from BioMed Valley Discoveries; grants from Boehringer Ingelheim; grants from Celator; grants and speakers’ bureau involvement from Celgene; grants from Forma; grants from Cyclacel; grants from Daiichi Sankyo; grants and speakers’ bureau involvement from Incyte; grants and speakers’ bureau involvement from Janssen; grants and consultant contract from Karyopharm; grants from Mateon; grants from National Marrow Donor Program; grants from National Institute of Health; grants from Novartis; grants from Onconova; grants from Pfizer; grants from Tolero; grants from Trovagene; grants from University of California, Davis; grants from Bluebird Bio; grants and speakers’ bureau involvement from Bristol-Myers Squibb; grants from Cellerant; grants from CTI Biopharma; grants from Gilead; grants from Donald Kohn; grants and speakers’ bureau involvement from Kite Pharma; grants from Medimmune; grants from Millennium; grants from Onyx; grants from PharmaMar; grants from Sangamo Therapeutics; grants from Stemline Therapeutics; grants from University of California; San Diego; grants from BiolineRx; grants from Gamida; consultant contract from Medallion; consultant contract from Medeor; consultant contract from Merck; grants and speakers’ bureau involvement from Pharmacyclics; speakers’ bureau involvement from Sanofi; advisory board membership from Seattle Genetics; consultant contract from Stanford University Health; consultant contract from Sunesis; grants and consultant contract from Takeda; speakers’ bureau involvement from Dava Oncology; speakers’ bureau involvement from Genzyme; and speakers’ bureau involvement from Jazz.

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Levin-Epstein, R., Oliai, C. & Schiller, G. Allogeneic Hematopoietic Stem Cell Transplantation for Older Patients With Acute Myeloid Leukemia. Curr. Treat. Options in Oncol. 19, 63 (2018). https://doi.org/10.1007/s11864-018-0577-2

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