Allogeneic hematopoietic cell transplant for acute myeloid leukemia: Current state in 2013 and future directions

Table 1 The European LeukemiaNet Standardized Reporting System for risk stratification of acute myeloid leukemia based on cytogenetics and molecular testing¹

Risk category	Cytogenetic abnormalities	Molecular abnormalities
Favorable risk	t(15;17) inv(16)/t(16;16)2t(8;21)2	CN-AML with biallelic CEBPA mutationCN-AML with NPM1 mutated but FLT3-ITD negative
Intermediate risk	CN-AMLt(9;11)All others abnormalities not classified as favorable or adverse risk	CN-AML with:NPM1 mutated/FLT3-ITD positiveNPM1 wild type/FLT3-ITD negativet(8;21)/inv (16) with c-KIT mutation
Adverse risk	inv (3)/t(3;3)	CN-AML with FLT3-ITD positive
	t(6;9)
	t(v;11)/MLL rearranged
	- 5/-5q
	-7
	Monosomal karyotype
	Abnormal 17p
	Complex cytogenetics

¹Table modified from Mrózek et al[24];

²The good prognosis of inv(16) and t(8;21) is maintained even with additional cytogenetic abnormalities. The presence of concomitant c-KIT mutation may increase relapse risk in t(8;21) and to lesser extend inv(16). CN-AML: Cytogenetically normal acute myeloid leukemia; CEBPA: CCAAT enhancer binding protein alpha; FLT3-ITD: FMS-like tyrosine kinase 3 gene-internal tandem duplication; MLL: Mixed lineage leukemia; NPM: Nucleophosmin.

Table 2 Cooperative group trial of allogeneic hematopoietic cell transplantation for acute myeloid leukemia in first complete remission

Cooperative group	Relapse rate			Disease free survival			Overall survival
	Allo	Auto	CC	Allo	Auto	CC	Allo	Auto	CC
EORTC/GIMEMA AML-8	24%1	41%	57%	55%1	48%1	30%	59%	56%	46%
GOELAM	37%	45%	55%	49%	48%	43%	55%	52%	58%
ECOG/CALGB/SWOG	29%1	48%	61%	43%	34%	34%	46%	43%	52%1
EORTC/GIMEMA AML-10	30%1	52%	-	52%1	42%	-	58%	50%	-
UK MRC AML-1023	36%1	52%		50%1	42%		55%	42%
HOVON-SAKK3	32%1	59%		48%1	37%		54%	46%

¹Represents statistically significant and favorable outcome with the treatment modality;

²The 4-year relapse rate, disease free survival and overall survival shown in all studies, except the UK-MRC AML-10 which reported 7-year outcomes;

³All studies designed to compare outcomes between allograft vs autograft vs consolidation chemotherapy except the UK MRC AML-10 and HOVON-SAKK trial which did not differentiate between autograft and chemotherapy. Allo: Allogeneic transplantation; auto: Autologous transplantation; CC: Consolidation chemotherapy.