Current Status and Perspectives of Allogeneic Hematopoietic Stem Cell Transplantation in Elderly Patients with Acute Myeloid Leukemia

Servais Sophie, Beguin Yves, Baron Frédéric, Servais Sophie, Beguin Yves, Baron Frédéric

Abstract

As in younger patients, allogeneic stem cell transplantation (alloHSCT) offers the best chance for durable remission in older patients (≥60 years) with acute myeloid leukemia (AML). However, defining the best treatment strategy (and in particular, whether or not to proceed to alloHSCT) for elderly patients with AML remains a difficult decision for the hematologist, since potential toxicity of conditioning regimens, risks of graft-versus-host disease, impaired immune reconstitution and the need for prolonged immunosuppression may be of major concern in these vulnerable patients with complex needs. Hopefully, significant progress has been made over the past decade in alloHSCT for elderly patients and current evidence suggests that chronological age per se (between 60 and 75) is not a reliable predictor of outcome after alloHSCT. Here, we review the current state of alloHSCT in elderly patients with AML and also discuss the different approaches currently being investigated to improve both accessibility to as well as success of alloHSCT in these patients.

Keywords: GVHD prophylaxis; acute myelogenous leukemia; comorbidity index; conditioning regimen; donor selection; elderly patients; geriatric assessment; hematopoietic stem cell transplantation; new drugs.

© The Author(s) 2022. Published by Oxford University Press.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/9154332/bin/szac015_fig4.jpg
Patient- and disease-related factors accounting for poorer prognosis after allogeneic stem cell transplantation in elderly AML patients in comparison with younger patients are depicted here. Strategies to improve the accessibility as well as success of alloHSCT in these patients are represented in orange circles.
Figure 1.
Figure 1.
Patient- and disease-related factors accounting for poorer prognosis after allogeneic stem cell transplantation in elderly patients with AML in comparison with younger patients are depicted here. Strategies to improve the accessibility as well as success of alloHSCT in these patients are represented in orange circles. AlloHSCT refers to allogeneic stem cell transplantation; AML, acute myeloid leukemia; AML-MCR, AML with myelodysplasia related changes; CR, complete remission; GVHD, graft-versus-host disease; ICT, intensive induction chemotherapy; MRD, minimal residual disease; NRM, non-relapse mortality; OS, overall survival; PFS, progression-free survival; QoL, quality of life; RIC, reduced intensity conditioning; t-AML, therapy-related AML.
Figure 2.
Figure 2.
Trends in alloHSCT for patients aged ≥ 65 years in the US over the past decades. Estimated annual number of alloHSCT acute leukemias, myelodysplastic syndrome, non-Hodgkin lymphoma, Hodgkin disease and multiple myeloma in patients aged ≥ 65 years in the US, as calculated based on the report published by the CIBMTR 2020.
Figure 3.
Figure 3.
Selected promising strategies to reduce relapse risk after alloHSCT in elderly patients with AML. AlloHSCT refers to allogeneic stem cell transplantation; BITEs, bispecific T-cell engager proteins; CAR, chimeric antigen receptor; CPI, checkpoint inhibitors; DARTS, dual-affinity retargeting proteins; FLT3, Fms-like tyrosine kinase 3; HMA, hypomethylating agents; IDH1/2, isocitrate dehydrogenase 1/2; mAb, monoclonal antibodies; NK, natural killer cells.

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Source: PubMed

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