Tham khảo tài liệu 'chapter 104. acute and chronic myeloid leukemia (part 10)', y tế - sức khoẻ, y học thường thức phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | Chapter 104. Acute and Chronic Myeloid Leukemia Part 10 Allogeneic SCT is used in patients 70 years old with an HLA-compatible donor who have high-risk cytogenetics. In the subset with normal cytogenetics and high-risk molecular features such as FLT3 ITD allogeneic SCT is best applied in the context of clinical trials as the impact of aggressive therapy on outcome is unknown. Relapse following allogeneic SCT occurs in only a small fraction of patients but toxicity is relatively high from treatment complications include venoocclusive disease GVHD and infections. Autologous transplantation can be administered in young and older patients and uses the same preparative regimens. Patients subsequently receive their own stem cells collected while in remission. The toxicity is lower with autologous SCT 5 mortality rate but the relapse rate is higher than with allogeneic SCT and randomized studies have not demonstrated outcome superior to postremission conventional-dose chemotherapy. The increased relapse rate is due to the absence of the graft-versus-leukemia GVL effect seen with allogeneic SCT and possible contamination of the autologous stem cells with tumor cells. Purging tumor from the autologous stem cells has not lowered the relapse rate with autologous SCT. Randomized trials comparing intensive chemotherapy and autologous and allogeneic SCT have shown improved duration of remission with allogeneic SCT compared to autologous SCT or chemotherapy alone. However overall survival is generally not different the improved disease control with allogeneic SCT is erased by the increase in fatal toxicity. While stem cells were previously harvested from the bone marrow virtually all efforts currently collect these from the blood following mobilization regimens including growth factors with or without chemotherapy. Prognostic factors may help select patients in first CR for whom transplant is most effective. Our approach includes considering allogeneic SCT in first CR for .
