Salvage Therapy after Allogeneic Hematopoietic Cell Transplantation: Targeted and Low-Intensity Treatment Options in Myelodysplastic Syndrome and Acute Myeloid Leukemia

Culos, Katie; Byrne, Michael

doi:10.2991/chi.d.190503.001

Cited by 8 publications

(7 citation statements)

References 51 publications

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“…This will likely increase the predictive value of pretransplant MRD status on relapse risk and OS above what has been observed with MRD positivity as currently ascertained in the EBMT registry database. Further, having these data in the registry will also benefit to study assessing the impact of prophylactic intervention such as posttransplant immunosuppression discontinuation, donor lymphocyte infusion, or targeted low-intensity therapies on leukemia progression [34][35][36][37][38][39].…”

Section: Discussionmentioning

confidence: 99%

Measurable residual disease (MRD) testing for acute leukemia in EBMT transplant centers: a survey on behalf of the ALWP of the EBMT

Nagler

Baron

Labopin

et al. 2020

Bone Marrow Transplant

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Detectable measurable residual disease (MRD) is a key prognostic factor in both acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) patients. Thus, we conducted a survey in EBMT transplant centers focusing on pre-and post-allo-HCT MRD. One hundred and six centers from 29 countries responded. One hundred had a formal strategy for routine MRD assessment, 91 for both ALL and AML. For ALL (n = 95), assessing MRD has been routine practice starting from 2010 (range, 1990-2019). Techniques used for MRD assessment consisted of PCR techniques alone (n = 27), multiparameter flow cytometry (MFC, n = 16), both techniques (n = 43), next-generation sequencing (NGS) + PCR (n = 2), or PCR + MFC + NGS (n = 7). The majority of centers assessed MRD every 2-3 months for 2 (range, 1-until relapse) years. For AML, assessing MRD was routine in 92 centers starting in 2010 (range 1990-2019). Assessment of MRD was by PCR (n = 23), MFC (n = 13), both PCR and MFC (n = 39), both PCR and NGS (n = 3), and by all three techniques (n = 14). The majority assesses MRD for AML every 2-3 months for 2 (range, 1-until relapse) years. This survey is the first step in the aim to include MRD status as a routine registry capture parameter in acute leukemia.

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Section: Discussionmentioning

confidence: 99%

Measurable residual disease (MRD) testing for acute leukemia in EBMT transplant centers: a survey on behalf of the ALWP of the EBMT

Nagler

Baron

Labopin

et al. 2020

Bone Marrow Transplant

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“…Accordingly, new data should be generated in this setting. 121,122 Most FLT3-mutat-EBMT ALWP recommendation for allo-SCT for FLT3 AML ed AML patients, however, are not currently receiving midostaurin, at least outside the USA and some other countries; therefore, for the foreseeable future, patients may still benefit from sorafenib maintenance treatment after allo-SCT. 1) 1-Indications for allogeneic stem-cell transplantation in FLT3-internal tandem duplication acute myeloid leukemia…”

Section: Post-transplant Maintenance In Flt3-mutated Acute Myeloid Leukemiamentioning

confidence: 99%

Clinical practice recommendation on hematopoietic stem cell transplantation for acute myeloid leukemia patients with FLT3-internal tandem duplication: a position statement from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation

et al. 2020

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“…56 In most cases, post-allo-HCT relapse is predictable, and deaths occur due to a limited number of effective treatment options and reduced access to novel compounds in clinical trials. [57][58][59] Effective, low-intensity maintenance therapies are necessary to improve disease-related outcomes after allo-HCT. At present, there are no maintenance therapies approved for MDS/AML patients after allo-HCT.…”

Section: Myeloid Neoplasmsmentioning

confidence: 99%

Maintenance Strategies After Hematopoietic Cell Transplantation

2020

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Hematopoietic cell transplantation (HCT) is an essential component of potentially curative therapy for patients with hematologic malignancies. High‐dose chemotherapy with autologous (auto) stem cell rescue is used to overcome chemoresistance in multiple myeloma, non‐Hodgkin lymphoma, and Hodgkin lymphoma. Alternatively, poor‐risk acute leukemias rely on the graft versus leukemia effect of allogeneic (allo) products. Long‐term remissions are feasible with both auto‐ and allo‐HCT; however, disease relapse is the leading cause of death after HCT for many patients. In recognition of this, novel therapies are being investigated in the upfront, relapsed/refractory, and post‐HCT maintenance settings to deepen response and maintain disease control. To date, the most robust data to support this approach are in multiple myeloma, where post‐transplant maintenance therapy has improved clinical outcomes. In Hodgkin lymphoma, patients with high‐risk features may benefit from post–auto‐HCT vedotin (BV) regardless of pre‐HCT BV exposure. Apart from mantle cell lymphoma, where rituximab maintenance is generally accepted, post–auto‐HCT maintenance in other forms of NHL is less established. In patients who undergo allo‐HCT, the utilization of maintenance therapy is an important component of improving post‐HCT outcomes, however, an individualized approach that considers patient factors such as residual toxicity from HCT, an immature graft with poor graft function, infection, and graft‐versus‐host disease create a complex environment for aggressive interventions. Initiation of directed agents in patients with identified mutations prior to allo‐HCT, including FLT3 in acute myeloid leukemia and Philadelphia chromosome in acute lymphoid leukemia have generally improved post‐HCT outcomes. Ongoing studies are exploring the safety and efficacy of additional maintenance strategies post–allo‐HCT in an effort to further improve post‐HCT outcomes.

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Salvage Therapy after Allogeneic Hematopoietic Cell Transplantation: Targeted and Low-Intensity Treatment Options in Myelodysplastic Syndrome and Acute Myeloid Leukemia

Cited by 8 publications

References 51 publications

Measurable residual disease (MRD) testing for acute leukemia in EBMT transplant centers: a survey on behalf of the ALWP of the EBMT

Measurable residual disease (MRD) testing for acute leukemia in EBMT transplant centers: a survey on behalf of the ALWP of the EBMT

Clinical practice recommendation on hematopoietic stem cell transplantation for acute myeloid leukemia patients with FLT3-internal tandem duplication: a position statement from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation

Maintenance Strategies After Hematopoietic Cell Transplantation

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