Leukemic patients eligible for allogeneic HSCT are divided into standard- and high-risk groups for transplantation.
Table 25-4. Advantages and Disadvantages of Allogeneic Hematopoietic Stem Cell Transplantation
1. Lower relapse rate
2. Graft versus leukemia effect2
1. Compatible donor availability limited (approximately 25-30% of siblings are compatible)
2. Graft versus host disease (GVHD), except in syngeneic (identical) twins
4. Increased risk of cytomegalovirus infection and interstitial pneumonia (this risk is 2.5 times greater in unrelated matched donors compared to matched siblings)
5. Risk of veno-occlusive disease greater in unrelated donors aThe relapse rate is 2.5 times lower in allogeneic recipients who have grade II-IV acute GVHD compared to recipients without GVHD. Leukemic cells have been reported to disappear during episodes of acute GVHD.
Table 25-5. Advantages and Disadvantages of Autologous Hematopoietic Stem Cell Transplantation
1. No need for an allogeneic donor
2. No GVHD
3. Lower risk of opportunistic infection (e.g., CMV, Pneumocystis carinii)
1. Increased risk of relapse (approximately 50%)
2. No graft versus leukemia effect
3. Graft failure due to:
a. Effect of in vitro purging b. Effect of previous chemotherapy and radiotherapy
Standard-Risk Leukemia Group
This group includes patients under 21 years of age with any of the following:
1. Acute myeloblastic leukemia (AML) in first or second remission
2. Acute lymphoblastic leukemia (ALL) in second or subsequent remission
3. High-risk leukemia (Chapter 14) in first remission
4. Chronic myelogenous leukemia (CML) in:
a. Chronic phase, b. Early accelerated stage, or c. Chronic phase after treatment for blast crisis
5. Juvenile chronic myelogenous leukemia (JCML) in first remission
6. Juvenile myelomonocytic leukemia (JMML)
High-Risk Leukemia Group
This group includes patients with any of the following:
1. Refractory acute leukemia (failed to achieve remission after two courses of conventional chemotherapy)
2. Acute leukemia in relapse
3. CML in accelerated or blastic phase.
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