The Role of Hematopoietic Stem Cell Transplantation in Adults with Acute Myeloid Leukemia

Advances in understanding of the molecular basis of acute myeloid leukemia (AML) are finally beginning to allow tailoring of therapy for patients based on relapse risk. Although remission-induction therapy for most patients today remains predominantly “one-fits-all” cytarabine-based chemotherapy, postremission treatments are becoming more individualized based on cytogenetic or molecular markers of disease. Successive cooperative group trials over the past decade have helped to clarify a role for allogeneic hematopoietic stem cell transplantation (HSCT) for patients with AML in first remission based on cytogenetic risk stratification. More recently, molecular risk stratification has also been helpful in identifying patients who benefit from early transplantation. Herein, we review the current state of allogeneic and autologous HSCT in AML, discuss the role for transplantation in patients with normal-karyotype leukemia, and provide practical recommendations for postremission strategies for AML in first complete remission. We also discuss the role for HSCT in advanced AML, for patients lacking suitable donors, and in older adults with reduced-intensity conditioning.