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EHA 2021 | Outcomes with RIC before second HSCT in secondary AML

Arnon Nagler, MD, Chaim Sheba Medical Center, Tel-Aviv, Israel, discusses the findings of a retrospective analysis of the role of secondary hematopoietic stem cell transplantation (HSCT) in patients with secondary acute myeloid leukemia (AML) who relapse after first transplantation. Prof. Nagler also talks on the rationale for the study, highlighting treatment of secondary AML as an unmet need and commenting on the poor outcomes of patients with secondary AML. The study compared myeloablative conditioning (MAC) versus reduced intensity conditioning (RIC) before HSCT in patients with secondary AML undergoing a second HSCT. This interview took place at the virtual European Hematology Association (EHA) Congress 2021.

Transcript (edited for clarity)

Secondary AML is an unmet need. Usually it’s, I mean, the result of treatment, conventional treatment in secondary AML was in primary AML, and also the results of allogeneic transplantation in secondary AML is usually was [inaudible] primary AML. Also, this is controversial, and this is because the patient in secondary AML, have seen previously chemotherapy, there’s more chromosomal abnormalities and more mutations, and usually the patient are also older and they’ve seen more chemotherapy...

Secondary AML is an unmet need. Usually it’s, I mean, the result of treatment, conventional treatment in secondary AML was in primary AML, and also the results of allogeneic transplantation in secondary AML is usually was [inaudible] primary AML. Also, this is controversial, and this is because the patient in secondary AML, have seen previously chemotherapy, there’s more chromosomal abnormalities and more mutations, and usually the patient are also older and they’ve seen more chemotherapy. So, they are with higher comorbidity and their tolerability to the chemotherapy is worse.

So, there is a question if we should subject this patient to reduced intensity of myeloablative conditioning. And we previously published a paper on a few other patients with secondary AML on behalf of the Acute Leukemia Working Party and reach the secondary AML was secondary to myelodysplastic syndrome because the secondary AML can be also secondary to a solid tumor breast cancer within a benign hematological disease. So, at that paper, we showed that in patients that are below the age of 50, they are better with myeloablative conditioning, than reduced intensity conditioning.

And so, now we look on the secondary AML and they compare the secondary, second transplant in secondary AML. And again, we compare the reduced intensity and myeloablative conditioning, and we were able to show that by the myeloablative conditioning in the second transplant, we reduce the relapse rate, and therefore improve the outcome of transplantation. And this though is somewhat hand-to-hand with our previous paper about the secondary AML after MDSs with first transplantation.

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