What is the impact of hematopoietic cell transplantation (HCT) for older adults with acute myeloid leukemia (AML)?

Acute myeloid leukemia (AML) patients over the age of 55 years are generally more difficult to treat than younger patients due to intrinsic drug resistance and diminished tolerance to treatment. The unfortunate result is that conventional chemotherapy is toxic and rarely curative. Recent studies suggest a better outcome for older AML patients treated with reduced-intensity conditioning (RIC) hematopoietic cell transplantation (HCT) than those treated with conventional chemotherapy. However, there are major limitations to RIC HCT. Some of these limitations may be able to be overcome, broadening the impact of allogeneic RIC HCT for older patients with AML. Ways to improve RIC HCT include making more patients eligible for RIC HCT by improving initial complete response rates using novel agents or combinations; finding a way to more rapidly identify alternative stem cell sources, such as by using donors that have already undergone HLA profiling or by using unrelated cord blood; eliminating the requirement for a complete response prior to transplant; and educating patients and physicians about the chances of survival after RIC HCT when compared to conventional chemotherapy.