CCONMDPSatellite2009Appelbaum异基因骨髓移植.pptVIP

AML, acute myeloid leukemia. ? How can all of these prognostic features be integrated? A very good response to the first cycle of chemotherapy with a clear bone marrow appears to be a good prognostic feature. Conversely, if the bone marrow is not clear, that appears to be a poor-risk feature. ? Assessing minimal residual disease after induction chemotherapy with multidimensional flow cytometry is an increasingly accurate means of determining prognosis. Wood and colleagues at our institution are using 9-color flow cytometry to detect as little as 0.005% blasts remaining in the bone marrow. This is similar to the accuracy of polymerase chain reaction and does not require any particular cytogenetic abnormality, so it is applicable for all subtypes of AML. In addition, the presence of minimal residual disease before an allogeneic transplantation may also influence outcome. To show transplantation is beneficial, there must be a differential effect on outcomes. ? Finally, an interesting approach to determine prognosis is to look at functional flow cytometry using phosphor flow imaging to see how many AML cells undergo apoptosis when exposed to conventional chemotherapy. * MRD, matched related donor; MUD, matched unrelated donor. ? Patients with AML in first remission and who have favorable cytogenetics should probably not be transplanted unless the AML is therapy related or they have c-KIT mutations. Intermediate-risk patients who have FLT3 mutations or do not have an NPM1 mutation should be transplanted. Transplantation is recommended for poor-risk patients. ? But what if there is no matched related donor? This study looked at outcomes using matched unrelated donors vs matched related donors. ? * URD, unrelated donor. ? In this group of 183 patients, the mortality with allogeneic transplantation using ablative regimens is essentially the same using matched related or unrelated donors. ? * URD, unrelated donor. ? Similarly, survival was virtually identical between th