摘要Adverse-risk acute myeloid leukemia(AML)is a therapeutic challenge despite advances in risk stratification.Unmet needs persist in high-risk molecular subgroups,such as AML with myelodysplasia-related changes,TP53 mutations,or rearrangements involving NUP98,NUP214,or FUS::ERG.These subtypes are associated with poor responses to conventional induction therapies and high relapse rates.Allogeneic hematopoietic stem cell transplantation(allo-HSCT)remains the cornerstone of consolidation for eligible patients;however,due to high relapse rates,regimen-related toxicity,and variable responses across genetic subtypes,optimal transplant timing,conditioning regimens(e.g.,busulfan-or melphalan-based protocols),and bridging strategies require further refinement.Meanwhile,post-transplant maintenance therapies,such as hypomethylating agents or targeted drugs,are one emerging area under investigation for relapse prevention.In this perspective,we review the latest advances in allo-HSCT strategies for adverse-risk AML and highlight the importance of molecularly-guided approaches to improve outcomes in these aggressive subtypes.