Allogeneic hematopoietic cell transplantation for patients with AML aged 70 years or older in first remission. A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)

Madon, E; Ngoya, Maud; Galimard, Jacques‐Emmanuel; Harbi, Samia; Kröger, Nicolaus; Platzbecker, Uwe; Sengeloev, Henrik; Craddock, Charles; Potter, Victoria; Choi, Goda; Chevallier, Patrice; Stölzel, Friedrich; Tholouli, Eleni; Maertens, Johan; Ciceri, Fabio; Cornelissen, Jan J.; Sanz, Jaime; Spyridonidis, Alexandros; Lanza, Francesco; Nagler, Arnon; Mohty, M

doi:10.1038/s41409-023-02027-y

Cited by 6 publications

(1 citation statement)

References 44 publications

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“…Overall, MAC should be the preferred regimen for patients in CR1 younger than 55 years, and it should be prospectively addressed whether those who achieve negative MRD could avoid some toxicity by receiving RIC [98,109]. Regarding allo-HSCT in patients older than 70 years, retrospective studies report the feasibility of this approach in selected patients in first remission, but prospective trials are needed to clarify the benefit in this population [112].…”

Section: Conditioning Intensitymentioning

confidence: 99%

Optimal Post-Remission Consolidation Therapy in Patients with AML

Jimenez-Chillon,

Dillon,

Russell

2023

Acta Haematol

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Background: Despite recent advances, 40–85% of patients with acute myeloid leukaemia (AML) achieve complete remission after intensive chemotherapy. However, without optimal treatment after remission, the risk of relapse remains high. Summary: A variable number of consolidation cycles consisting of intermediate doses of cytarabine are the most commonly used regimens in low-intermediate-risk AML, while patients at higher risk of relapse should consolidate response by proceeding to HSCT. Different post-consolidation (maintenance therapies) have demonstrated their benefit in prolonging relapse-free survival, and others are still under investigation. Careful consideration should be given to which patients benefit most from each of these interventions, considering that the risk of relapse is dynamic. Key Messages: Patients consolidated with chemotherapy should receive either 2 courses of HDAC or no more than 3–4 cycles of IDAC with dose reduction in patients over 60 years. Patients with mutated FLT3 AML benefit from post-consolidation maintenance with FLT3 inhibitors, and selected patients not fit for adequate consolidation may benefit from CC-468 maintenance. Patients at higher risk of relapse should proceed to allogeneic SCT as soon as possible, opting for a more intensive conditioning in patients younger than 55 years. However, autologous HSCT may still have role in favourable-risk MRD-negative AML. Multiple treatment options targeting MRD are emerging, either as definitive treatment or as a bridge to allogeneic transplantation, and are likely to become increasingly relevant.

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Section: Conditioning Intensitymentioning

confidence: 99%