Journal of Leukemia
Open Access

Stem Cell Transplantation as a Curative Strategy in Acute Myeloid Leukemia

Tobias Lehmann^{* *}Correspondence: Tobias Lehmann, Department of Experimental Hematology, University of Zurich, Zurich, Switzerland, Email:

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Description

Leukemia, a diverse group of hematologic malignancies, arises from the uncontrolled proliferation of abnormal white blood cells in the bone marrow and peripheral blood. Despite significant advancements in chemotherapy, targeted therapies, and supportive care, leukemia continues to pose substantial challenges due to its heterogeneity, chemoresistance, and frequent relapses. Over the past several decades, stem cell transplantation has emerged as a cornerstone in the management of leukemia, offering the possibility of long-term remission and, in many cases, a potential cure. Stem cell transplantation, broadly categorized as autologous and allogeneic, involves replacing the diseased or damaged hematopoietic system with healthy hematopoietic stem cells derived from bone marrow, peripheral blood, or umbilical cord blood. This procedure capitalizes on the regenerative capacity of stem cells and, in the case of allogeneic transplantation, the immunologic potential of donor cells to eradicate residual leukemic cells.

Autologous stem cell transplantation involves harvesting a patient’s own hematopoietic stem cells before administering high-dose chemotherapy or radiotherapy and then reintroducing the cells to restore bone marrow function. This approach primarily provides a means to administer intensive cytoreductive therapy while mitigating the prolonged aplasia that would otherwise occur. Autologous transplantation has shown significant benefits in patients with certain subtypes of leukemia, particularly in multiple myeloma and select cases of Acute Myeloid Leukemia (AML) and Acute Lymphoblastic Leukemia (ALL). The major advantage of this approach lies in the elimination of immunologic complications such as Graft-Versus- Host Disease (GVHD), which can be life-threatening in allogeneic transplantation. However, its limitation stems from the absence of the Graft-Versus-Leukemia (GVL) effect, which is a crucial immunologic mechanism whereby donor immune cells target residual leukemic cells. Consequently, autologous transplantation may be associated with higher relapse rates compared to allogeneic procedures in high-risk leukemia subtypes.

Allogeneic stem cell transplantation, on the other hand, entails the transfer of hematopoietic stem cells from a compatible donor, which could be a matched sibling, unrelated volunteer, or haploidentical donor. This method not only restores the patient’s bone marrow following intensive therapy but also provides a potent immunologic effect through the GVL response, which is central to preventing relapse. Allogeneic transplantation has become a standard curative option for various high-risk or relapsed leukemias, including AML, ALL, Chronic Myeloid Leukemia (CML) in advanced phases, and certain aggressive forms of Chronic Lymphocytic Leukemia (CLL). The curative potential of this approach is particularly evident in patients achieving complete remission prior to transplantation, as the combination of cytoreductive conditioning and donor immune surveillance significantly reduces minimal residual disease and relapse risk.

Despite its curative potential, stem cell transplantation is not without considerable risks and challenges. The conditioning regimens, often involving high-dose chemotherapy with or without total body irradiation, can result in profound myelosuppression, mucositis, organ toxicity, and heightened susceptibility to infections. In allogeneic transplantation, the risk of GVHD, both acute and chronic, remains a major cause of morbidity and mortality. GVHD occurs when donor immune cells recognize host tissues as foreign and initiate an inflammatory response, affecting organs such as the skin, liver, and gastrointestinal tract. While prophylactic immunosuppressive strategies and advanced supportive care have reduced the incidence and severity of GVHD, it remains a formidable challenge. Additionally, post-transplant relapse and graft failure continue to be significant hurdles, underscoring the need for meticulous donor selection, conditioning optimization, and vigilant post-transplant monitoring.