Correcting 2 more myths regarding transplants for AML in second remission

摘要

A recent Blood Perspective report by Forman and Rowe challenged the myth that in persons with acute myeloid leukemia (AML) in first remission, one can take a wait-and-see approach: if relapse occurs persons in second remission can undergo transplantation. The authors correctly suggest that few people with recurrent AML achieve second remission and are fit to proceed to a transplant. This leads them to conclude that transplants in persons with AML in first remission should be more often considered, especially persons with minimal residual disease (MRD) who may have an increased likelihood of relapse. What precisely MRD is and how it is defined are not specified, which is potentially problematic. Although we agree that second remissions are infrequent in persons who relapse, these data do not necessarily result in recommending transplants in first remission because it perpetuates 2 other myths: (1) that only persons who achieve a second remission benefit from a transplant and (2) that we can accurately predict at the subject level which persons with AML in first remission are likely to relapse.