The blind spots of post-transplant AML relapse: from clinical signal to mechanism-matched therapy.

Authors

Michael D Ashby, David J Curtis

Published in

Blood reviews. Pages 101437. Oct 23, 2026. Epub Oct 23, 2026.

Abstract

Relapse after allogeneic haematopoietic stem cell transplantation remains the dominant cause of death in acute myeloid leukaemia (AML), and outcomes after relapse remain poor despite substantial advances in supportive care, monitoring and therapy. Contemporary practice includes detailed monitoring and offers an expanding therapeutic toolkit including GVHD prophylaxis, engineered grafts, maintenance and targeted therapies. The biological understanding required to apply these tools selectively has, however, not kept pace. In this review we present an integrated clinical approach that connects the monitoring signal at impending relapse to the mechanism of graft-versus-leukaemia failure and the mechanism-matched therapeutic choice. We comprehensively review transplant care from conditioning through maintenance and relapse and highlight unresolved questions organised around graft versus host disease and graft versus leukaemia, fixed or reversible mechanisms of failure and maintenance therapies. We use TP53-mutated AML as an integrated case study of multi-mechanism failure. We conclude with practice points, a research agenda, and future considerations for the mechanism-defining studies required to make further progress.

PMID:
42928031
Bibliographic data and abstract were imported from PubMed on 26 Oct 2026.

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