Special Topics In Transplantation For Aml Stem cell source

As in ALL, trials have prospectively enrolled patients to determine if outcomes using PBSC are superior, equivalent, or inferior to stem cell transplantation. The Stem Cell Trialists group demonstrated in an individual-patient meta-analysis that for all hematologic malignancies, disease-free outcomes were slightly superior for PBSC transplantation, although this was not seen in the AML subgroup. In a large retrospective IBMTR review, outcome for patients with AML in first remission was no different for PBSCT in comparison with BMT (1 year DFS 70% vs 61%, p = 0.25); however, patients in second remission benefited significantly with PBSCT (1 year DFS 77% vs 57%, p = 0.003).99 This is in contrast to a large EBMT survey where no differences were noted,100 and a second EBMT survey where CD34+ rich stem cell transplantation was associated with improved outcome for patients with AML in first remission.101

The use of umbilical cord transplantation has been explored for patients with AML, and until recently was considered outside a clinical trial only when a sibling or suitable unrelated donor was not available. Two recent trials have recently demonstrated that although there are differences in rates of GVHD and time to engraftment with cord blood transplantation, long-term outcomes are similar to unrelated stem cell trans-plantation.102 103 Whether cord blood transplantation is equivalent to unrelated PBSC transplantation is unknown.

0 0

Post a comment