| Abstract [eng] |
Acute myeloid leukaemia is an aggressive haematological disease characterized by rapid progression and poor prognosis. For many patients, despite intensive treatment, the disease relapses or remains refractory to therapy. In such cases, treatment options are limited, and alternative or investigational therapeutic approaches are often considered. One such method is sequential allogeneic hematopoietic stem cell transplantation, which represents a potential therapeutic strategy for this patient group. Evaluation of this method is important for its potential application in clinical practice. Aim and objectives. To analyse treatment strategies for refractory/relapsed acute myeloid leukaemia using sequential allogeneic hematopoietic stem cell transplantation. To evaluate clinical and treatment-related factors influencing outcomes and survival. Methods. A literature review was conducted analysing treatment strategies of sequential allogeneic hematopoietic stem cell transplantation in relapsed and refractory acute myeloid leukaemia. Literature search was performed using the PubMed database. The following keywords were used: “acute myeloleukemia“, “acute myeloid leukaemia”, “allogeneic stem cell transplantation”, “sequential allogeneic stem cell transplantation”, “refractory AML”, “relapsed AML”. Reviews, systematic reviews, and clinical trials published in English were included. Results. Analysis of sequential allogeneic hematopoietic stem cell transplantation treatment methods showed that a lower blast percentage prior to transplantation is an important prognostic factor associated with reduced non-relapse mortality. Improved overall survival is observed in patients who undergo transplantation at an earlier stage of disease and after fewer cycles of chemotherapy. Mild acute graft-versus-host disease (grade I–II) is associated with more favourable outcomes, whereas severe graft-versus-host disease (grade III–IV) significantly worsens prognosis. The risk of graft-versus-host disease is reduced using anti-T-lymphocyte antibodies and transplantation from matched related donors. Prophylactic donor lymphocyte infusions are associated with improved survival. Compared to intensive reinduction chemotherapy, sequential allogeneic hematopoietic stem cell transplantation is associated with a lower incidence of severe infections, however, the risk of relapse remains high. The main causes of adverse outcomes are infections and complications of graft-versus-host disease. Negative prognostic factors include older age, higher blast percentage (>20%), longer time to transplantation, and mismatched donors. Conclusions. Sequential allogeneic hematopoietic stem cell transplantation is a promising treatment approach for patients with very poor prognosis refractory/relapsed acute myeloid leukaemia. To reduce post-transplant relapse risk, it is essential to minimize treatment-related toxicity as well as the incidence of infections and severe graft-versus-host disease. |
