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EBMT 2025 | Transplanting patients with advanced AML
Arnon Nagler, MD, Chaim Sheba Medical Center, Tel-Aviv, Israel, comments on the current treatment landscape for advanced acute myeloid leukemia (AML), highlighting that stem cell transplantation (SCT) remains the primary treatment approach for patients with high-risk and relapsed disease. Prof. Nagler outlines some key topics discussed in his “Meet the Expert” session on this topic at the EBMT 2025 conference. This interview took place at the 51st Annual Meeting of the EBMT in Florence, Italy.
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Transcript
CAR T-cells revolutionized treatment in lymphatic malignancies. However, CAR T-cells are only in the infancy in myeloid malignancies. We treated a few patients with AML with 8q21 translocation that expressed CD19 with our in-house. This is the flexibility story. But for most of the patients with AML, MDS, and myeloproliferative disorders, there is no CAR T-cell yet...
CAR T-cells revolutionized treatment in lymphatic malignancies. However, CAR T-cells are only in the infancy in myeloid malignancies. We treated a few patients with AML with 8q21 translocation that expressed CD19 with our in-house. This is the flexibility story. But for most of the patients with AML, MDS, and myeloproliferative disorders, there is no CAR T-cell yet. No product approved, but also the clinical studies are only starting because it’s, I mean, the targets that we have on myeloid cells is much less efficient than the CD19 on lymphatic cells and there are more off-target effects. So transplant is the way to cure patients with intermediate and high-risk AML.
We have in the recent years some development in specific drugs against mutations, especially the FLT3 mutation, the KMT2A, so the menin inhibitors, and IDH1 and IDH2. but still many of the leukemic patients I mean are not cured by this specific inhibitor and not all of them are approved in Europe and we just add them now to the traditional induction therapy.
So most of the AML high-risk for depend on transplant to cure them. Also we have relapsing patients, we have patients with primary refractory disease, so under advanced AML patient we have few categories, either high risk or relapsed or primary refractory or relapsed after salvage therapy and for this patients we need transplantation.
Now the advantage of transplant nowadays is that we have a donor for almost all the patients and in time because we have really improved haploidentical transplant. So what we discuss in this meet the expert is to which patient to offer transplant, in which scenario, what drugs or medications to give pre-transplant, what drug we need to give post-transplant, is there donor lymphocyte infusion or hypomethylating agent or venetoclax or specific inhibitor post-transplant maintenance therapy that the disease will not relapse. The importance of minimal residual disease to transplant. So this is the whole field, you know, to cover. But transplantation is really the hope for this patient with advanced AML in the current practice.
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