The Acute Myeloid Leukemia Channel on VJHemOnc is an independent medical education platform, supported with funding from BMS (Silver), and through an educational grant from Jazz Pharmaceuticals. Supporters have no influence on the production of content. The levels of sponsorship listed are reflective of the amount of funding given.
The Community Focus Channel on VJHemOnc is an independent medical education platform, supported with funding from Johnson & Johnson (Gold). Supporters have no influence on the production of content. The levels of sponsorship listed are reflective of the amount of funding given.
ISAL 2025 | Managing patients with NPM1-mutated AML: should alloSCT be used in CR1?
Boaz Nachmias, MD, PhD, Hadassah Medical Center, Jerusalem, Israel, comments on the management of patients with acute myeloid leukemia (AML) with NPM1 mutations, highlighting the challenges of deciding whether to proceed with allogeneic stem cell transplantation (alloSCT) in first complete remission (CR1). Dr Nachmias notes that subgroups of patients may benefit more from alloSCT in CR1, and those who do not undergo transplant can be salvaged with venetoclax-based therapies, achieving similar outcomes. This interview took place at the 19th International Symposium on Acute Leukemias (ISAL XIX) in Munich, Germany.
These works are owned by Magdalen Medical Publishing (MMP) and are protected by copyright laws and treaties around the world. All rights are reserved.
Transcript
So we know that NPM1 is favorable, but some of the patients have clear positive MRD at the end of two cycles, and these patients need to go to transplant. But others are either low positive MRD for NPM1, so then you wonder what to do, or have other perhaps high-risk features such as FLT3 ITD mutation. And even when they achieve MRD negativity, they are considered intermediate risk, so you wonder what to do...
So we know that NPM1 is favorable, but some of the patients have clear positive MRD at the end of two cycles, and these patients need to go to transplant. But others are either low positive MRD for NPM1, so then you wonder what to do, or have other perhaps high-risk features such as FLT3 ITD mutation. And even when they achieve MRD negativity, they are considered intermediate risk, so you wonder what to do. So one option is to ask if you are able to salvage them at relapse with similar outcomes. And then you can maybe take the risk and not go to transplant at CR1, because obviously the morbidity and mortality of allogeneic transplant is significant. So that’s basically what we did. And we looked at all of these patients who did not go to transplant in CR1 and looked at the outcome. And we have two major insights from this study. One is a patient above the age of 60 or have FLT3 ITD most likely will relapse, even regardless of their MRD situation, especially in the elderly population. So these are high-risk patients for relapse. But on the other hand, once we give them either salvage or VEN-AZA-based treatments at relapse, we can achieve similar outcomes at this stage with transplants. And so I think that in certain patient populations, we can take the risk, not go to transplant in CR1, have close monitoring for this patient, and at any sign of molecular relapse, do preventive therapy and go to transplant with similar outcomes at the end, and perhaps save transplant for a fraction of patients.
This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.
Read more...
Disclosures
Honoraria: Abbvie.
