Debating the Need for Pretransplant Treatment in R/R AML

Основні поняття

Immediate allogeneic transplant without complete remission may be as effective as intensive salvage induction therapy in relapsed or refractory AML.

Анотація

The debate at the Society of Hematologic Oncology (SOHO) meeting focused on the necessity of pretransplant treatment in patients with relapsed or refractory acute myeloid leukemia (AML). The discussion revolved around the effectiveness of proceeding directly to allogeneic hematopoietic stem cell transplant (alloHCT) without achieving complete remission compared to undergoing intensive salvage induction therapy to induce remission before transplant. Key findings from the phase 3 ASAP trial were presented, challenging traditional approaches to AML treatment. The debate highlighted contrasting viewpoints on the impact of residual disease on posttransplant outcomes and the importance of achieving complete remission before transplantation.

Highlights

• Debate on the necessity of pretransplant treatment in relapsed or refractory AML patients
• Comparison of immediate alloHCT without complete remission versus intensive salvage induction therapy
• Findings from the ASAP trial challenging conventional treatment strategies
• Impact of residual disease on posttransplant outcomes
• Importance of achieving complete remission before transplantation

Статистика

"In an intention-to-treat analysis, 83.5% of patients in the disease control group and 81% in the remission-induction group achieved treatment success."
"Patients in the disease-control arm experienced significantly fewer severe adverse events (23% vs 64% in the remission induction arm) and spent a mean of 27 fewer days in the hospital prior to transplantation."
"Patients who had a complete response prior to transplantation demonstrated significantly better overall survival at 4 years than those who had not had a complete response."

Цитати

"This is what I was really astonished about." - Johannes Schetelig
"To me, it's still key to go into transplant with as little disease as possible." - Ronald B. Walter

Ключові висновки, отримані з

Is Additional Treatment Needed Pretransplant in R/R AML?

by Neil Osterwe... о www.medscape.com 09-11-2023

https://www.medscape.com/viewarticle/996287

Глибші Запити

What are the implications of the ASAP trial findings on current AML treatment guidelines?

The ASAP trial findings have significant implications for current AML treatment guidelines. The trial demonstrated that immediate allogeneic transplant without achieving complete remission following induction therapy can be just as effective as receiving intensive salvage induction therapy before transplant. This challenges the traditional approach of ensuring complete remission before proceeding to transplant in patients with relapsed or refractory AML. The study showed that patients who underwent watchful waiting prior to transplant had similar outcomes in terms of leukemia-free survival and overall survival compared to those who received intensive salvage induction therapy. These findings suggest that for some patients, watchful waiting may be a viable alternative to intensive pretransplant therapy. This could potentially lead to a shift in treatment strategies for AML patients who do not achieve complete remission with induction therapy.

How can the balance between reducing disease burden and minimizing toxicity be achieved in pretransplant therapy?

Achieving a balance between reducing disease burden and minimizing toxicity in pretransplant therapy is crucial in optimizing outcomes for AML patients. One approach to strike this balance is through personalized treatment strategies based on individual patient characteristics and disease biology. Tailoring therapy to each patient's specific needs can help reduce unnecessary toxicity while effectively targeting residual disease. Additionally, utilizing targeted therapies or immunotherapies that have a more favorable toxicity profile can help minimize treatment-related adverse events. Close monitoring of patients' response to therapy and adjusting treatment plans accordingly can also help optimize the balance between reducing disease burden and minimizing toxicity. Collaborative decision-making involving a multidisciplinary team of healthcare providers can further enhance the individualized approach to pretransplant therapy.

How might the debate on pretransplant treatment strategies impact the future of AML management?

The debate on pretransplant treatment strategies could have a significant impact on the future of AML management by influencing treatment guidelines and clinical practice. The contrasting viewpoints presented in the debate highlight the complexity of decision-making in pretransplant therapy for AML patients. As more evidence emerges regarding the efficacy and safety of different approaches, the debate may lead to a paradigm shift in how AML patients are treated before undergoing allogeneic stem cell transplant. This could result in a more personalized and tailored approach to pretransplant therapy, with a focus on optimizing outcomes while minimizing treatment-related toxicity. The ongoing discussion and research in this area may lead to the development of novel treatment strategies and guidelines that better address the diverse needs of AML patients, ultimately improving the overall management and outcomes of the disease.