ISAL 2025 | A study investigating the outcome of alloSCT in therapy-related myeloid neoplasms

Yes, so we collected data on transplant done in patients with therapy-related myeloid neoplasm and in particular to patients who develop these disorders after receiving chemotherapy and PARP inhibitors for ovarian cancers. And we were very interested in these patients because of course they have very dismal outcomes and also because PARP inhibitors are used more and more in oncology, so not only in ovarian cancer but also in breast cancer and prostate cancer and so there is a real issue there because probably in the coming years we will have more and more patients with these disorders. It has been shown by us and others that therapy-related myeloid neoplasm can arise in around five to eight percent of women who receive chemotherapy for ovarian cancer plus PARP inhibitor maintenance. And for this reason, the clinical need is actually very high in this specific field. We collected patients from different Italian institutions, such as Yale in Milano, Bologna and Roma Gemelli, and we treated 11 patients with bone marrow transplant for therapy-related acute myeloid leukemia. As expected, the biology of these disorders was very aggressive. In fact, most of them had the P53 mutation and around half of them also had the complex karyotype. And all these patients were in complete remission of their ovarian cancer at the moment of the acute myeloid leukemia diagnosis. They received induction therapy 10 out of 11. The 11th patient just received upfront transplant because she had myelodysplasia and the outcomes of the transplant were as expected in terms of engraftment and also in terms of graft-versus-host disease. The results we got in terms of disease control were again as expected in such an aggressive pathology and in fact seven out of these 11 patients failed the transplant, five of them because of acute myeloid leukemia relapse and two of them because of transplant-related toxicity. On the other side there are four patients who are alive with a six months follow-up, median follow-up at this time point and what is really interesting is that one of them because of relapsing ovarian cancer is now able to receive OC-directed chemotherapy. So altogether of course the results are again not incredible as expected in such a specific population with such aggressive disorders but I think it’s important to keep in mind that again there’s a clinical need for these patients because we know that P53 and secondary acute myeloid leukemia are very aggressive so the need is there. Probably in the coming years because people with cancer are surviving more we will have more and more patients having secondary AML and again the PARP inhibitors are used in more and more disorders so we will face more and more patients with these disorders. And we as we just listened today and in the last couple of days there’s hope also for p53 so there’s STING inhibition there’s MCL1 inhibition. So hopefully we’ll find ways also to have better results in such an aggressive disorder.

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