ISAL 2025 | Selecting patients with AML for alloSCT and strategies to improve post-transplant outcomes

So, the first thing I would like to say is that bone marrow transplant really should be considered as a part in the patient journey. So we should not consider transplant as something different from the old process, the old journey of a patient with acute myeloid leukemia, who starts of course with induction, consolidation, then also transplant comes in. So when we consider a transplant, we should really consider on one side the biology of the disease, how aggressive it is, and also the history of the patient, which chemotherapy received, which consolidation therapy received, which comorbidities he has before the leukemia story and also that were accumulated during the disease. And finally, and very importantly also, the MRD results that we got with the treatment. And according to all of this, then we can decide if we can offer and if we can allocate a patient to transplant. Again, considering on one side the biology of disease and also the condition of the patient, the comorbidities. And so we really need to make, trying to understand the pros and cons of such a complicated procedure when we are offering to our patient, keeping in mind that more or less we are reducing by 50% the risk of relapse when we transplant a patient with acute myeloid leukemia. And again, keeping in mind all of this information, we can decide a transplant which is customized to a specific patient on a specific disease and this is how we can get better results. And with this I mean choosing a conditioning chemotherapy which can be myeloablative or reduced intensity conditioning or again we can use different GvHD prophylaxis and even more importantly according to the disorder to the biology of disease we should consider how quickly to taper the immunosuppressant after transplant because as easy as this is but this is a very relevant therapeutic act that we can use to get better results in terms of graft versus leukemia. And then again considering the fact that the transplant should not be considered anymore as the last bit and the last therapy for our patients, there are all different approaches that we can use in order to ameliorate and have better results after transplant. So on one side we can do many things in order to facilitate and somehow quicken the graft versus leukemia effect and we can do this again reducing and tapering a bit quicker the immunosuppressive agent or also using DLI or all different lymphocytes that can be used again to facilitate graft versus leukemia and as we heard again in this nice meeting here there’s new space now for maintenance therapy and there are very new there’s a lot of new therapeutic agents for sure FLT3 inhibitors TKI for acute lymphoblastic leukemia and there are new data and new trials using oral azacitidine for maintenance after transplant also menin inhibitors such as enzomenib after transplant so again the field is expanding and I really think that we should work more and more transplant physician, hematologist, leukemia expert in order to understand how to better treat our patients.

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