Acute Leukemias And Myelodysplastic Syndromes

Acute myelogenous leukemia (AML), along with acute lymphocytic leukemia (ALL), were some of the first malignancies in which HSCT was demonstrated to have efficacy.19 2181 Initial studies of myeloablative allogeneic HSCT demonstrated that this treatment was capable of resulting in long-term survival for a minority of patients with refractory and relapsed AML.81 Subsequent studies suggested that a GVL effect contributed to the success of allogeneic HSCT in AML.1921 The evidence for a GVL effect in ALL is less convinc-ing.95 In contrast to data in CML, the clinical responses of relapsed AML and ALL to DLI are generally less than 50%, with particularly disappointing results for ALL.25,52,95 A number of antigens have been identified as potential targets in AML, explaining the efficacy of allogeneic HSCT in this disease. These antigens are expressed only on a minority of AML cells, and on normal tissues.96-98 Similarly, the response of myelodys-plastic syndrome to DLI is relatively poor, although allogeneic HSCT is the only known curative therapy for patients with MDS.99

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