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IACH Focus on Leukemia 2020 | Allo-HSCT and novel drugs for refractory AML

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Mohamad Mohty

Mohamad Mohty, MD, PhD, Saint-Antoine Hospital, Paris, France, discusses allogeneic hematopoietic cell transplantation (allo-HSCT). In allogeneic HSCT, the aim of conditioning is to eradicate existing tumor cells. After the graft infusion, maintenance therapies include hypomethylating agents (HMAs), FLT3 inhibitors and venetoclax. The outcome for refractory acute myeloid leukemia (AML) will continue to improve as novel drugs synergize with the transplantation procedure. This interview took place during the 2020 Annual Meeting of the International Academy for Clinical Hematology (IACH).

Transcript (edited for clarity)

When it comes to allogeneic stem cell transplantation in refractory AML, I think this has been made popular more than 10 years ago thanks to the so-called, FLAMSA or FLAMSA-like regimens. So the concept is about including as part of the preparative regimen before transplant two sequences. One initial sequence is about chemotherapy trying to debulk the disease, trying to eliminate as much as we can in terms of leukemic cells...

When it comes to allogeneic stem cell transplantation in refractory AML, I think this has been made popular more than 10 years ago thanks to the so-called, FLAMSA or FLAMSA-like regimens. So the concept is about including as part of the preparative regimen before transplant two sequences. One initial sequence is about chemotherapy trying to debulk the disease, trying to eliminate as much as we can in terms of leukemic cells. Then immediately followed after two or three days of rest by the conditioning regimen and then infusion of the graft. And once engraftment is achieved, the philosophy is also about delivering some form of a therapy after.

Of course, donor lymphocyte infusion can be done but these days I think we are using more and more targeted therapies. Hypomethylating agents are widely used, a FLT3 inhibitors are also used after transplant in the FLT3 ITD population. But now also we see drugs targeting the apoptosis pathways like venetoclax. So clearly I believe the results of allo-transplant for refractory AML will continue to improve over time and we owe this to the synergy between the transplant procedure itself, the allogeneic immune effect but also to the novel agents, novel mechanism of action. So joining forces there in order to control the acute myeloid leukemia disease.

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