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EBMT 2021 | allo-SCT in refractory AML: FLAMSA approaches

Mohamad Mohty, MD, PhD, Saint-Antoine Hospital, Paris, France, discusses allogeneic stem cell transplantation (allo-SCT) for patients with refractory acute myeloid leukemia (AML), highlighting FLAMSA (fludarabine-amsacrine-cytarabine) approaches. Prof. Mohty reports that the FLAMSA approach can achieve a 30-35% leukemia-free survival rate in patients with AML, at two years of follow-up. This interview took place during the 47th Annual Meeting of the European Group for Blood and Marrow Transplantation (EBMT) 2021.

Transcript (edited for clarity)

This is really a very exciting era when it comes to novel drugs in acute myeloid leukemia. And we are very fortunate having half a dozen, if not more than nine, seven, I stopped counting them, FDA approvals for new drugs in AML.

However, when it comes to relapse/refractory AML, we need to acknowledge that none of these treatments is curative and there is still room in a significant number of patients for allogeneic stem cell transplantation...

This is really a very exciting era when it comes to novel drugs in acute myeloid leukemia. And we are very fortunate having half a dozen, if not more than nine, seven, I stopped counting them, FDA approvals for new drugs in AML.

However, when it comes to relapse/refractory AML, we need to acknowledge that none of these treatments is curative and there is still room in a significant number of patients for allogeneic stem cell transplantation. So in another word, if we have a patient who’s relatively young, fit, who is a suitable donor, we should not neglect the option of allogeneic stem cell transplantation.

And this has been the philosophy of the FLAMSA or FLAMSA-like approach, which is about like combining a sort of a cytoreductive treatment, plus a conditioning regimen followed by transplantation, and some interventions after transplantation to prevent disease recurrence.

And today, when we look to the available evidence from retrospective studies, but also from prospective data, we can appreciate that we can achieve something around 30 to 35% leukemia-free survival at two years, which is really highly significant in the population of relapse/refractory AML.

So today, having a huge variety of donors, especially with the advent of haplo donors, we should really never neglect this allotransplant option when it comes to relapse/refractory AML, because we can achieve some long-term survival in a subgroup of patients.

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