ASH 2025 | The COSI trial: addition of thiotepa to improve outcomes in patients with AML undergoing alloSCT

Yes, the COSI trial was delivered by the UK Transplant Trial Network, IMPACT, and it looked at the really important question about whether by adding an additional cytotoxic drug, in this case, thiotepa, we could improve outcomes for patients allografted for AML in CR1 using either a myeloablative or reduced intensity transplant. And the take-home message was that in both the myeloablative and the reduced intensity setting, if you look at all comers, there was no beneficial impact on disease-free survival or overall survival. And the reason for that was, although there was a significant reduction in relapse, in the whole population, there was a marked uptick in transplant-related mortality. So I don’t think we would say that this is a new standard of care. But what is very interesting is that in patients with pre-transplant MRD positivity, there was a particularly marked reduction in relapse risk. This was to some extent offset by the increased transplant-related mortality. So I think the opportunity going forward is to design transplant regimens, including thiotepa, which have acceptable toxicity, but plausibly this is an agent that we can be applying to patients who have evidence of pre-transplant MRD positivity.

This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.