Allogeneic hematopoietic stem-cell transplantation (HCT) is one of the principal curative approaches in the treatment of acute myeloid leukemia (AML); however, relapse post-transplantation remains a catastrophic event with poor prognosis. The incidence of relapse has remained unchanged over the last three decades despite an evolving understanding of the immunobiology of the graft-versus leukemia effect and the immune escape mechanisms that lead to post-HCT relapse. The approach to post-transplant relapse is highly individualized and is dictated both by disease biology and genomics as well as the patient's clinical status at the time of relapse and the interval between relapse and transplantation. With the help of three illustrative cases, we discuss our approach to early, late, and incipient relapse. Current therapeutic strategies incorporate immunosuppression taper when feasible, a variety of targeted and non-targeted chemotherapeutic agents and consolidative cellular therapies including donor lymphocyte infusions or a second allogeneic transplant. We then summarize evolving frontiers in the treatment and prognostication of relapse including the critical role of measurable residual disease. Finally, we emphasize enrollment on clinical trials and thoughtful discussions regarding goals of care and supporting frail patients as universal principles that should be incorporated in approaches to treatment of AML relapse post-transplantation.

中文翻译：

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我如何治疗同种异体 HCT 后的 AML 复发。


同种异体造血干细胞移植 （HCT） 是治疗急性髓性白血病 （AML） 的主要治疗方法之一;然而，移植后复发仍然是一个预后不良的灾难性事件。尽管对移植物抗白血病效应的免疫生物学和导致 HCT 后复发的免疫逃逸机制的理解不断加深，但在过去三十年中，复发的发生率一直保持不变。移植后复发的处理方式高度个体化，受疾病生物学和基因组学以及患者复发时临床状态以及复发与移植之间的间隔等因素决定。在三个说明性案例的帮助下，我们讨论了我们处理早期、晚期和早期复发的方法。目前的治疗策略包括免疫抑制在可行的情况下逐渐减量、各种靶向和非靶向化疗药物以及巩固细胞疗法，包括供体淋巴细胞输注或第二次同种异体移植。然后，我们总结了复发治疗和预后不断发展的前沿，包括可测量残留病的关键作用。最后，我们强调参加临床试验并就护理目标和支持虚弱患者进行深思熟虑的讨论，作为应纳入移植后 AML 复发治疗方法的普遍原则。