The treatment of acute myelogenous leukemia (AML) has 2 steps: the first step involves therapy to get it into remission, and the second step involves therapy to prevent it from coming back. Over several decades our approach to the first step has largely remained the same, but our approach to the second step has evolved significantly. The fundamental clinical decision for the second step has become: is the prospect for durable control better with posttransplantation chemotherapy or with hematopoietic cell transplantation?
In the late 1990s, the use of reduced-intensity conditioning regimen (RIC) was a major paradigm shift in the field of stem cell transplantation. The main idea was to harness the graft-versus-tumor (GVT) effect to achieve the ultimate goal of cure without the need for toxic myeloablative therapy. It became clear that engraftment after RIC can result in mixed donor chimerism adequate to correct the medical problem without subjecting the patient to short- and long-term toxicities associated with myeloablative transplantation regimens.
Front Line Therapy For Multiple Myeloma And Mantle Cell Lymphoma: The Role of Hematopoietic Cell Transplantation and Proteasome Inhibition Therapies
The management of multiple myeloma has changed dramatically over the past 2 decades. Testing of new treatment options continues at a rapid pace. The advances have resulted in improved survival rates not only in clinical trial participants, but these benefits have been applied to general practice and survival rates are improving in population-based studies as well. Although cure largely remains beyond a realistic prospect, durable control of disease is achievable in the majority of patients.
Although the myelodysplastic syndromes (MDS) are not curable without hematopoietic cell transplant (HCT), advances in non-transplant therapies today offer considerable benefit to our patients. Over the years, prognostic algorithms have been developed and validated and these are useful guides to allow us to more accurately predict the likely trajectory of disease progression in a group of syndromes that have a notorious heterogeneity.