chapter  23
10 Pages

Mechanisms of Cure of Acute Myeloid Leukemia with Allogeneic Transplantation

ByFrederick R. Appelbaum

I. INTRODUCTION Although the precise role of allogeneic transplantation in the treatment of acute myeloid leukemia (AML) continues to be discussed and refined, there is no argument that this therapeutic technique is able to cure patients who are incurable by any other means. The clearest examples are patients who fail initial induction chemotherapy. Such patients are incurable with any nontransplant approach, yet several studies have documented longterm disease-free survival in approximately 20% of induction-failure patients if treated with allogeneic transplantation (1,2). Similarly, many studies have demonstrated that 1520% of patients who have relapsed from an initial remission and have failed attempts at reinduction can still be cured with transplantation (3). Recently, the question of the appropriate timing of allogeneic transplantation in AML has tended to dominate most discussions, and although it is important to define which patients are best served by being treated with allogeneic transplantation in first remission versus those who may better benefit by withholding transplantation until first relapse, this debate should not obscure the fact that allogeneic transplantation cures otherwise incurable patients. Understanding the mechanisms by which transplantation achieves this result should allow for further improvements in transplantation and may have relevance for other approaches as well.