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EBMT 2025 | Is there a preferable donor for alloSCT in secondary AML in first complete remission?
In this interview, Arnon Nagler, MD, Chaim Sheba Medical Center, Tel-Aviv, Israel, discusses the preferable donor type for allogeneic stem cell transplantation (alloSCT) in patients with secondary acute myeloid leukemia (AML) and how this compares to de novo AML. Prof. Nagler highlights the findings of a study of the Acute Leukemia Working Party (ALWP) of the EBMT, which investigated the effect of donor type in patients with secondary AML in first complete remission (CR1). This interview took place at the 51st Annual Meeting of the EBMT in Florence, Italy.
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Transcript
Secondary AML is a unique category of AML with specific mutations, and the patients with secondary AML respond poorly to the conventional treatment these days with a CR rate of only 40% compared to 80% in the primary de novo AML and also overall survival of seven months. And this is because more mutations, patients are elderly, they respond less to chemotherapy, they tolerate less chemotherapy...
Secondary AML is a unique category of AML with specific mutations, and the patients with secondary AML respond poorly to the conventional treatment these days with a CR rate of only 40% compared to 80% in the primary de novo AML and also overall survival of seven months. And this is because more mutations, patients are elderly, they respond less to chemotherapy, they tolerate less chemotherapy. So this is a niche in which we can improve.
Transplant is working in secondary AML, but we have published in the Acute Leukemia, the transplant in secondary AML from sibling and unrelated donor are less effective than transplant from sibling and unrelated donor in de novo AML. And then in two papers in the last two years, we show that haploidentical transplant in secondary AML are the exact results like the de novo AML. We did it in one study for CR patient and complete remission, and the second one we did it in active disease. So haploidentical transplant may overcome some of the bad signals of secondary AML.
Now the haplo is with PTCy, or post-transplant cyclophosphamide, and the question is if what is the best donor for transplant in secondary AML because there was no study with formal comparison. So we compared in secondary AML haploidentical transplant, sibling transplant and unrelated transplantation, and it turned out to be that sibling transplant is still the best with better overall survival and with less transplant-related mortality. So the transplant-related mortality was 40% in haploidentical and 20% with sibling transplantation. However, the relapse rate was higher with the sibling transplantation. But at the end of the day, the overall survival and leukemia-free survival and GRFS were better with a sibling transplantation.
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