Premium
A critical review of which children with acute myeloid leukaemia need stem cell procedures
Author(s) -
Hasle Henrik
Publication year - 2014
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.12900
Subject(s) - medicine , hematopoietic stem cell transplantation , npm1 , minimal residual disease , oncology , transplantation , stem cell , disease , immunology , pediatrics , leukemia , karyotype , biology , biochemistry , chromosome , gene , genetics
Summary The last decades have seen parallel improvements in chemotherapy‐based and haematopoietic stem cell transplantation ( HSCT ) regimens for acute myeloid leukaemia ( AML ) in children. There has been no consensus on indication for HSCT . Reserving HSCT for high‐risk and relapsed patients spare many patients from the long‐term toxicity of this treatment. The results of matched unrelated donor HSCT equal family donor transplantation and the presence of a matched sibling should no longer be a transplant indication. Minimal residual disease measured by flow cytometry may identify poor responders benefitting from HSCT in first complete remission ( CR 1) and those with a favourable response to induction therapy who do not need HSCT even with adverse cytogenetic aberrations. FLT 3 ‐internal tandem duplication without NPM 1 mutation has a very high relapse rate despite favourable response and HSCT is indicated in CR 1 in these cases. Finding the optimal indications for HSCT is a delicate balance between risk of relapse and late effects.