Stem cell transplantation in acute myeloid leukemia; history, drivers and challenges.

Authors:Paul Faduola
Int J Biol Med Res. 2012; 3(3): 2132-2137  |  PDF File

Abstract

ABSTRACT Stem cell therapy for Acute Myeloid Leukemia (AML) involves the transfusion of multipotent cells derived from bone marrow, peripheral or cord blood. Cells are harvested from the same individual (autologous) before leukemic cells have been destroyed using chemotherapy or radiation therapy, and returned post marrow ablation; alternatively replacement post ablation can be from an HLA-matched donor (allogeneic). One disadvantage in allogeneic transplants is the development of a potentially lethal immune response, graft versus host disease (GVHD). An advantage of allogeneic grafts is the potential for a graft-versus leukemia (GVL) response, where the renewing immune system destroys residual malignant cells; this can be an important contribution to achieving remission. Because the autologous option makes use of stem cells from the patient, the possibility of malignant contamination remains, and there is no GVL response; the advantage however is that autologous grafts do not cause GVHD.A major obstacle to HSC therapy is immunological rejection. Technological advances in genomics and proteomics, gene therapy as well as improved stem cell banking technology have the potential to improve the clinical utilization of hematopoietic stem cells for AML therapy.