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Dr. Ehab Atallah: Results highlight the need for increased awareness post-transplant for the possibility of VOD
Dr. Atallah scans the journals, so you don’t have to!

Ehab Atallah, MD
This month, a study by Sasaki et al (Cancer. 2021 Apr 5) has finally demonstrated statistically significant improved survival for patients with de novo AML from 1980 to 2017. The overall survival was 9% from 1980-1989, 15% from 1990-1999, 22% from 2000-2009, and 28% from 2010-2017. The improvement in survival was worst for patients > 70 years old. In that age group, the survival improved from 1% from 1980 to 9889 to 5% after that period. These results are encouraging with tripling of the overall survival in 4 decades. Most of this improvement could perhaps be attributed to better supportive care, more use of high dose cytarabine consolidation, and better stem cell transplantation outcomes. In the last 2-3 years several highly effective therapies such as venetoclax, ivosidenib, enasidneib, midostaurin and giltretinib have been approved. With these new agents we would expect an improved survival for patients with AML, especially in the older population. We will be looking forward to seeing a SEER analysis for survival after 2017.


Two recently published studies added to our knowledge on the clinical benefit of gemtuzumab in patients with AML. The first study by Bouvier A et al demonstrated no survival benefit with the addition of gemtuzumab in patients with intermediate risk AML. The second study by Duncan et al was a retrospective study by the CIBMTR. That study demonstrated increased risk of VOD in pediatric patients who received gemtuzmab. However, overall survival and event free survival was similar in both groups. These results highlight the need for increased awareness post-transplant for the possibility of VOD, and also reduces concern regarding overall survival for patients receiving gemtuzumab.

Another study by the EBMT (Debaja et al) evaluated factors affecting the outcome of patients with AML receiving a second allogeneic HCT. Outcome was worse for patients not in CR and those with a short time from allo-HCT.  Overall survival was similar for patients receiving a MUD or haploidentical donor. Two year overall survival was 31% vs. 29% for patients receiving MUD vs. haploidentical allo-HCT. This study clearly expands options for patients receiving a second allo-HCT. In addition, a prior study by EBMT demonstrated no difference in overall survival between patients receiving same vs. different vs. haplo donor.

 

Finally, a large study by the CIBMTR (Percival et al) demonstrated that in AML patients, achieving CRi and having persistent MRD prior to transplantation were associated with worse outcome compared to CR with no evidence of MRD. The adjusted 5 year survival for patient with CR/MRD-ve, CR/MRD+ve, CRi/MRD-ve and CRi/MRD+ve was 52%, 37%, 44% and 34% respectively.

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Ehab L. Atallah, MD

Medical College of Wisconsin

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Medical College of Wisconsin

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Medical College of Wisconsin

Dr. Atallah scans the journals, so you don’t have to!
Dr. Atallah scans the journals, so you don’t have to!

Ehab Atallah, MD
This month, a study by Sasaki et al (Cancer. 2021 Apr 5) has finally demonstrated statistically significant improved survival for patients with de novo AML from 1980 to 2017. The overall survival was 9% from 1980-1989, 15% from 1990-1999, 22% from 2000-2009, and 28% from 2010-2017. The improvement in survival was worst for patients > 70 years old. In that age group, the survival improved from 1% from 1980 to 9889 to 5% after that period. These results are encouraging with tripling of the overall survival in 4 decades. Most of this improvement could perhaps be attributed to better supportive care, more use of high dose cytarabine consolidation, and better stem cell transplantation outcomes. In the last 2-3 years several highly effective therapies such as venetoclax, ivosidenib, enasidneib, midostaurin and giltretinib have been approved. With these new agents we would expect an improved survival for patients with AML, especially in the older population. We will be looking forward to seeing a SEER analysis for survival after 2017.


Two recently published studies added to our knowledge on the clinical benefit of gemtuzumab in patients with AML. The first study by Bouvier A et al demonstrated no survival benefit with the addition of gemtuzumab in patients with intermediate risk AML. The second study by Duncan et al was a retrospective study by the CIBMTR. That study demonstrated increased risk of VOD in pediatric patients who received gemtuzmab. However, overall survival and event free survival was similar in both groups. These results highlight the need for increased awareness post-transplant for the possibility of VOD, and also reduces concern regarding overall survival for patients receiving gemtuzumab.

Another study by the EBMT (Debaja et al) evaluated factors affecting the outcome of patients with AML receiving a second allogeneic HCT. Outcome was worse for patients not in CR and those with a short time from allo-HCT.  Overall survival was similar for patients receiving a MUD or haploidentical donor. Two year overall survival was 31% vs. 29% for patients receiving MUD vs. haploidentical allo-HCT. This study clearly expands options for patients receiving a second allo-HCT. In addition, a prior study by EBMT demonstrated no difference in overall survival between patients receiving same vs. different vs. haplo donor.

 

Finally, a large study by the CIBMTR (Percival et al) demonstrated that in AML patients, achieving CRi and having persistent MRD prior to transplantation were associated with worse outcome compared to CR with no evidence of MRD. The adjusted 5 year survival for patient with CR/MRD-ve, CR/MRD+ve, CRi/MRD-ve and CRi/MRD+ve was 52%, 37%, 44% and 34% respectively.

Ehab Atallah, MD
This month, a study by Sasaki et al (Cancer. 2021 Apr 5) has finally demonstrated statistically significant improved survival for patients with de novo AML from 1980 to 2017. The overall survival was 9% from 1980-1989, 15% from 1990-1999, 22% from 2000-2009, and 28% from 2010-2017. The improvement in survival was worst for patients > 70 years old. In that age group, the survival improved from 1% from 1980 to 9889 to 5% after that period. These results are encouraging with tripling of the overall survival in 4 decades. Most of this improvement could perhaps be attributed to better supportive care, more use of high dose cytarabine consolidation, and better stem cell transplantation outcomes. In the last 2-3 years several highly effective therapies such as venetoclax, ivosidenib, enasidneib, midostaurin and giltretinib have been approved. With these new agents we would expect an improved survival for patients with AML, especially in the older population. We will be looking forward to seeing a SEER analysis for survival after 2017.


Two recently published studies added to our knowledge on the clinical benefit of gemtuzumab in patients with AML. The first study by Bouvier A et al demonstrated no survival benefit with the addition of gemtuzumab in patients with intermediate risk AML. The second study by Duncan et al was a retrospective study by the CIBMTR. That study demonstrated increased risk of VOD in pediatric patients who received gemtuzmab. However, overall survival and event free survival was similar in both groups. These results highlight the need for increased awareness post-transplant for the possibility of VOD, and also reduces concern regarding overall survival for patients receiving gemtuzumab.

Another study by the EBMT (Debaja et al) evaluated factors affecting the outcome of patients with AML receiving a second allogeneic HCT. Outcome was worse for patients not in CR and those with a short time from allo-HCT.  Overall survival was similar for patients receiving a MUD or haploidentical donor. Two year overall survival was 31% vs. 29% for patients receiving MUD vs. haploidentical allo-HCT. This study clearly expands options for patients receiving a second allo-HCT. In addition, a prior study by EBMT demonstrated no difference in overall survival between patients receiving same vs. different vs. haplo donor.

 

Finally, a large study by the CIBMTR (Percival et al) demonstrated that in AML patients, achieving CRi and having persistent MRD prior to transplantation were associated with worse outcome compared to CR with no evidence of MRD. The adjusted 5 year survival for patient with CR/MRD-ve, CR/MRD+ve, CRi/MRD-ve and CRi/MRD+ve was 52%, 37%, 44% and 34% respectively.

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