How do doctors decide if a child with AML needs a bone marrow transplant?

How do doctors decide if a child with AML needs a bone marrow transplant?

So we have a lot of known risk factors for patients to be unlikely to be cured with chemotherapy alone. And those really help us guide which patients get referred on for a bone marrow transplant.

The first is if they have very high risk features at their diagnosis as part of their leukemia, whether it's this leukemia arose after treatment for another cancer as a consequence from chemotherapy, if this is a leukemia that arose from a broken bone marrow with something called myelodysplastic syndrome, or specific features of leukemia, and there are many of these things, like specific genetic mutations or molecular activations that happen within the leukemia cells that tell us that this is a high risk cancer, that we've learned from all of these patients that we've treated before.

Additionally, patients that do not get into remission with their first round of chemotherapy, it is thought that their leukemia is more resistant to chemotherapy or their cancer is more resistant to chemotherapy. And therefore, we need to rely on this graph versus leukemia effect, the immunotherapy that we have with a bone marrow transplant for these patients, in order to give them a chance for a long standing cure.

Additionally, and patients that did not need a bone marrow transplant when they were first diagnosed with their AML, should they have a relapse of their disease. We know that those patients will require a bone marrow transplant for an expectation of cure.