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Relapse after HSCT 2021 | New developments in AML treatment

Thomas Schröder, MD, Essen University Hospital, Essen, Germany, discusses new developments in the pre-transplant and maintenance fields of acute myeloid leukemia (AML). Firstly, measurable residual disease (MRD)-driven pre-emptive therapies may be beneficial to optimize outcomes following allogeneic hematopoietic stem cell transplantation (alloHSCT). In addition, several drugs are being evaluated in the post-transplant maintenance setting. This includes azacitidine and gilteritinib, which is currently being investigated in patients with FLT3-mutated AML in the Phase III MORPHO trial (NCT02997202). Chimeric antigen receptor T-cell therapy strategies are also being explored, but are currently associated with significant challenges. This interview took place at the 2021 Relapse After HSCT² Workshop in New York, NY.

Transcript (edited for clarity)

With regard to pre-transplant strategies, we might see whether we can optimize it in the way that more people are getting MRD negative prior to transplant. That could be one option, but the problem is, we don’t have the tools for it so far, different from acute lymphoblastic leukemia, where we have, for example, blinatumomab or rituximab. That is not the case in AML.

So, I think that we will move forward to start very early with pre-emptive therapies driven by MRD...

With regard to pre-transplant strategies, we might see whether we can optimize it in the way that more people are getting MRD negative prior to transplant. That could be one option, but the problem is, we don’t have the tools for it so far, different from acute lymphoblastic leukemia, where we have, for example, blinatumomab or rituximab. That is not the case in AML.

So, I think that we will move forward to start very early with pre-emptive therapies driven by MRD. And yes, and then we probably will try some of the drugs we have already. For example, also as a maintenance therapy, we have the MORPHO trial. Results are expected with regard to gilteritinib, and there might be also others, like oral Aza, that might move into the field for a maintenance therapy. And in those who already suffer from relapse and I already mentioned, I would say that we will probably have a more individualized treatment for those patients.

And finally, but I’m not sure how far that will go, we might also have cellular therapies also in AML patients, but the problem at so far is that the target is also present on non-malignant cells. And this is the limitation of this approach in the myeloid diseases so far.

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Disclosures

Thomas Schröder, MD, has received research funding, speakers honoraria and consulting fees from Celgene.

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