Predictive strategies for poor outcomes after allotransplantation in patients with acute myeloid leukemia: what are the options and when should clinicians use them?

INTRODUCTION: Allotransplantation can provide a curative option for many AML patients. Over the past decade, an expanding array of predictive tools has been effectively used to identify high-risk patients with poor outcomes, enabling personalized treatment strategies. These advances have made precision medicine a reality for AML patients undergoing allogeneic transplantation, ultimately improving survival outcomes. The published articles were searched from Web of science with the keywords of 'stem cell transplantation' or 'bone marrow transplantation' (subject) and 'acute myeloid leukemia.'

AREAS COVERED: We first discussed the predictive biomarkers for poor outcomes in AML patients after allotransplantation. We also summarized the clinical utility of biomarkers in guiding optimal donor selection, conditioning regimen optimization, as well as prophylaxis, maintenance, and preemptive therapy for transplantation complications in AML patients, with a primary focus on leukemia relapse and GVHD. we highlighted the challenges and future directions in the field of biomarker-directed transplantation complication prediction and therapy.

EXPERT OPINION: Advances in biomarker-based prediction of transplant complications, prophylactic strategies, and preemptive therapy have made precision medicine a reality for AML patients. Future efforts should focus on identifying novel biomarkers to develop new techniques for predicting poor outcomes and guiding personalized prophylaxis and therapy.