Transplants in the AML Treatment Landscape


Naval G. Daver, MD, discusses how stem cell transplants factor into the current treatment landscape of acute myeloid leukemia.

AML treatment has seen a surge in stem cell transplants, not just due to improved transplant techniques, but also thanks to gentler therapies like hypomethylating agents (HMA) and venetoclax (Venclexta). These newer drugs induce similar remission rates as chemotherapy, but with far fewer side effects. This keeps older patients in much better shape post-remission, making them much more likely to tolerate and benefit from a transplant. Transplant rates in this age group have consequently jumped from 10-15% to nearly 40%, marking a significant shift in AML care, according to Naval G. Daver, MD, associate professor in the Department of Leukemia at MD Anderson Cancer Center.


0:09 | I mean, I think in general, we're doing more stem cell transplants than we used to, and I don't think that is predominantly only because we're more enthusiastic to do transplants or transplant procedures have improved. That may be part of it, but I think a lot of it is just because we are getting more patients into remission with less toxicity, especially when you think about older [patients], above 65 or above 70. You know, historically, we used to have to give them either intensive chemo, anthracycline/cytarabine, and then we would see a lot of toxicities. So even though the remission rate was high, 70-75%, a lot of the patients would develop significant mucositis, trochleitis, infections, fatigue, and we decondition, and then by the time they were in remission, they go to transplant, the transplanters were not comfortable because they were in a poor performance status with a high risk of transplant-related mortality.

0:55 | Now with the HMA/ven, that problem has been solved, to a large extent, because now we're seeing still the response rates, similar to what we were getting with intensive chemo, close to 70-75%, but much less mucositis, trochleitis, severe neutropenic infection, sepsis, so patients achieved remission, are in good condition, and especially in above 65, where we used to transplant only 10-15%, I think we're transplanting close to 40% of those patients. So I think that is probably the biggest area where the transplant rate overall in AML has gone up compared to 5-10 years ago.

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