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What is the role of a second allogeneic hematopoietic cell transplant in relapsed acute myeloid leukemia?

Bone Marrow Transplantation volume 55, pages 325–331 (2020)Cite this article

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Abstract

Relapsed acute myeloid leukemia (AML) after an allogeneic hematopoietic cell transplant (allo-HCT) entails a poor prognosis. Treating these cases is challenging due to lack of effective therapies and, in some cases, poor performance status and/or presence of graft-versus-host disease (GVHD), among others. No randomized controlled trial (RCT) has ever been conducted comparing a second allo-HCT against other treatments. Existing data are mainly from observational studies or registries. Success of a second allo-HCT is dependent on appropriately selecting patients who might achieve best outcomes with reasonable non-relapse mortality (NRM) risk. Several factors are associated with worse outcomes, namely a shorter time from first allo-HCT to relapse or to the second allo-HCT, and AML not being in complete hematologic remission (CR). Patients relapsing earlier than 6 months or having active/persistent disease should be enrolled in clinical trials. Limitations of the published literature include retrospective small size studies, a heterogeneous population, and absence of information on somatic mutations, among others. Future studies assessing the role of a second allo-HCT should evaluate the impact of IDH1, IDH2, or others on outcomes; and the feasibility and efficacy of targeted therapies in the pre-, peri-, or post-second allo-HCT setting.

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Authors and Affiliations

  1. Section of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon

    Nour M. Moukalled

  2. Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapies Program, Mayo Clinic, Jacksonville, FL, USA

    Mohamed A. Kharfan-Dabaja

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  1. Nour M. Moukalled
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Correspondence to Mohamed A. Kharfan-Dabaja.

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M.A.K-D. is a consultant for Daiichi Sankyo. N.M.M. declares that he has no conflict of interest.

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Moukalled, N.M., Kharfan-Dabaja, M.A. What is the role of a second allogeneic hematopoietic cell transplant in relapsed acute myeloid leukemia?. Bone Marrow Transplant 55, 325–331 (2020). https://doi.org/10.1038/s41409-019-0584-3

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