iwAL 2026 | Maximizing the graft-versus-leukemia effect after allogeneic transplantation in AML
Charles Craddock, CBE, FRCP(UK), FRCPath, DPhil, FMedSci, University of Birmingham, Birmingham, UK, discusses strategies for maximizing the graft-versus-leukemia effect following allogeneic stem cell transplantation in acute myeloid leukemia (AML). He highlights the potential roles of myeloablative conditioning, early post-transplant measurable residual disease (MRD) assessment, rapid immunosuppression tapering and donor lymphocyte infusion in patients at high risk of relapse. This interview took place at the 8th International Workshop on Acute Leukemias (iwAL 2026), held in Boston, MA.
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Transcript
Yes, I think we are increasingly recognizing that the graft versus leukemia effect is highly effective. In fact, it’s our most potent anti-leukemic tool. And the opportunities to maximize the anti-leukemic effect of a transplant are presented in a number of ways. In younger, fit adults who are MRD positive, the use of a myeloablative regimen is associated with better outcomes. That’s one...
Yes, I think we are increasingly recognizing that the graft versus leukemia effect is highly effective. In fact, it’s our most potent anti-leukemic tool. And the opportunities to maximize the anti-leukemic effect of a transplant are presented in a number of ways. In younger, fit adults who are MRD positive, the use of a myeloablative regimen is associated with better outcomes. That’s one. In patients who are having a reduced-intensity transplant, we can think about rapid tapering of immunosuppression in patients with a high predicted risk of relapse. And underpinning that approach is, I think, in 2026, a recognition that standard of care is early assessment for post-transplant, presence of post-transplant MRD. We used to do a bone marrow at day 100. I think now we should be routinely in high-risk patients looking at a bone marrow performed between day 28 and day 40. And it’s those patients who should have a particularly rapid taper of immunosuppression. And then finally, for patients who are MRD positive or who you deem to be at very high risk of relapse, the use of donor lymphocyte infusion is largely safe and can be very effective.
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