Transplantation for secondary AML

Therapy-related AML or AML arising from a myelodys-plastic syndrome (collectively, secondary AML, sAML)

is considered incurable with standard chemotherapeu-tic approaches. Secondary AML is often associated with adverse cytogenetic features including loss of part or all of chromosome 7, loss of chromosome 5q, translocations involving MLL gene at 11q23, or a complex karyotype with multiple cytogenetic aberrations. As in de novo AML, these cytogenetic changes are associated with poor prognosis104 and wherever possible a suitable allogeneic donor should be identified once secondary AML is diagnosed.105 106 Since many patients with sAML are of advanced age, the less toxic approaches of autologous and nonmyeloablative stem cell transplantation have been used with varying degrees of success. The EBMT reported outcomes in 173 patients with MDS or secondary AML who underwent autologous transplantation. The risk of relapse was 55%, which was higher than for allogeneic stem cell recipients.107 There are currently no long-term studies supporting the use of autologous transplantation for sAML. Allogeneic transplantation is the preferred therapeutic modality, leading to long-term remission in approximately 20-30%, when ablative conditioning is utilized.105-108

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