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ASH 2024 | Non-T-depleted haploidentical transplantation in patients with secondary AML
Arnon Nagler, MD, Chaim Sheba Medical Center, Tel-Aviv, Israel, comments on the value of non-T-depleted haploidentical transplantation in patients with secondary acute myeloid leukemia (AML) in first complete remission (CR). Prof. Nagler notes that secondary AML typically has a poorer prognosis than de novo AML, with a lower overall survival rate and lower CR rates. However, he reports that non-T-depleted haploidentical transplantation with post-transplant cyclophosphamide (PTCy) can achieve similar outcomes to de novo AML in patients in first CR, with a graft-versus-leukemia effect that can rescue approximately 60% of patients. This interview took place at the 66th ASH Annual Meeting and Exposition, held in San Diego, CA.
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Transcript (AI-generated)
Secondary AML is a distinct type of AML, usually with poorer prognosis than the de novo AML, because the patients are elderly, because we have more adversaries in cytogenetics, patients tolerate less chemotherapy, and they are more resistant. So usually the overall survival is like seven months and the CR rate is only 40 to 50%. And previously in the acute leukemia working party, we compared a transplant from sibling and unrelated in secondary AML versus the normal AML and showed that the results with secondary were inferior...
Secondary AML is a distinct type of AML, usually with poorer prognosis than the de novo AML, because the patients are elderly, because we have more adversaries in cytogenetics, patients tolerate less chemotherapy, and they are more resistant. So usually the overall survival is like seven months and the CR rate is only 40 to 50%. And previously in the acute leukemia working party, we compared a transplant from sibling and unrelated in secondary AML versus the normal AML and showed that the results with secondary were inferior. Substantively, we looked at haploidentical transplant in secondary AML because non-T depleted haploidentical transplant with PTCy reduced the transplant-related mortality and incidence of GvHD and may be associated with a stronger graft-versus-leukemia effect and we show indeed that with haploidentical transplant in the secondary AML, results are similar to the de novo AML in patients that are in the first complete remission and the haplo can rescue about 60% of the patients and also in patients with relapse or refractory disease, when we compared haplo in secondary AML versus the de novo AML, we can rescue 30% of the patients and the results were similar. But it’s not known if bone marrow or peripheral blood are the best graft source because in peripheral blood maybe you have a stronger GvL effect. So we compared the bone marrow and peripheral blood for patients with haploidentical transplants with PTCy and secondary AML and did not show better outcomes with the peripheral blood. So we failed to show a stronger graft versus leukemia effect with peripheral blood in haplo with secondary AML compared to the bone marrow grafts.
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