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Life after transplant: are we becoming high maintenance in AML?

Bone Marrow Transplantation volume 51, pages 1423–1430 (2016)Cite this article

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Abstract

Allogeneic hematopoietic cell transplantation (allo-HCT) for patients with AML is increasingly able to impact the historically poor outcomes in this disease. Nonetheless, even with transplant, the rates of post-HCT relapse are unacceptably high, and remain a great challenge in the treatment of patients with AML. Maintenance therapies after allo-HCT, given to patients at high risk of relapse or with evidence of minimal residual disease (MRD), may provide a way to reduce relapse rates and improve survival. New therapies may offer acceptable toxicity profiles in the post-HCT setting, and investigations are ongoing using hypomethylating agents, histone deacetylase inhibitors, immunomodulatory drugs, targeted tyrosine kinase inhibitors, drug–antibody conjugates and cellular therapies. Future directions in the field of post-HCT therapies may include better risk stratification with MRD, as well as the exploitation of novel mechanisms such as immune checkpoint inhibition and modified chimeric antigen receptor (CAR) T cells. In this mini review, we discuss the current landscape of clinical research in post-HCT maintenance therapies, as well as future therapeutic strategies of interest. Although there is great potential for post-HCT agents to improve AML outcomes, these will need to be evaluated prospectively through well-designed randomized clinical trials.

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Acknowledgements

AMB is supported in part by National Institutes of Health (NIH) grant T32 CA 71345-18.

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  1. Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA

    A M Brunner, A T Fathi & Y B Chen

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ATF has participated on advisory boards for Agios and Merck and received funding for clinical research from Celgene and Takeda. YBC has received consulting fees from Bayer, Seattle Genetics and Takeda, and funding for clinical research from Celgene, Novartis, Takeda, Bayer and Seattle Genetics. AMB declares no conflict of interest.

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Brunner, A., Fathi, A. & Chen, Y. Life after transplant: are we becoming high maintenance in AML?. Bone Marrow Transplant 51, 1423–1430 (2016). https://doi.org/10.1038/bmt.2016.160

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