Thus, patients with a predicted relapse risk of more than 50% are likely to benefit from an allograft
providing it can be delivered with a TRM in the region of 15%. By similar reasoning patients with a
higher risk of disease relapse are, in principle, candidates for a transplant procedure with a higher
TRM.
Using a donor: versus no donor methodology studies have demonstrated improved disease free
survival and overall survival in patients with intermediate or adverse risk cytogenetics transplanted
using an HLA identical sibling donor. In patients with good risk cytogenetics and a low predicted risk
of relapse if treated with chemotherapy alone most studies have failed to demonstrate improved OS
after allo-SCT since any reduction in relapse risk is offset by TRM. Future decision making concerning
the role of allo-SCT in adults with AML will reflect not only improvements in outcome for patients
treated with IC alone but also the impact of strategies, such as post-transplant pharmacological
maintenance therapy, with the potential to improve transplant outcome (5,6)
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