EHA 2016
Risk adapted therapy for acute myeloid leukaemia
Prof Jorge Sierra - Hospital de Sant Pau, Barcelona, Spain
The study we present here is summarising the preliminary results of our current trial for patients with primary acute myeloid leukaemia aged 18-80. The main results of this trial reflect that the complete remission rate using a rather conventional combination of idarubicin and cytarabine leads to almost 80% complete remissions in patients up to the age of 70 which is a rather high remission. Another important observation is that if you take into account the molecular criteria of diagnosis and the minimal residual disease after consolidation chemotherapy you may avoid allogeneic transplantation and its risks in more than 40% of patients which is rather important because still nowadays we have between 15-20% one year mortality in allotransplants for AML in the first year. Also in patients without a favourable profile still there is a lot of work to do because despite that practically 80% of the patients were transplanted in this high risk group which is a proportion which is very high compared to other trials most of them relapsed after the procedure because they are negatively selected because they had high risk molecular features or because they had positive minimal residual disease at the end of chemotherapy. So in this group, which is basically composed by FLT3, ITD mutants without Mpn1 mutation and also it’s composed by patients with advanced cytogenetics, something else has to be done. Now we have several opportunities because we have many targeted therapies. Some of them like FLT3 inhibitors have already demonstrated an added value to chemotherapy and eventually also to transplant. So I think it’s going to be mandatory to combine before and after transplant these new targeted therapies and also that we have to explore immune interventions after the procedure, after the transplantation, in order to potentiate the graft versus tumour effect and reduce relapses.
You mentioned these were just the preliminary results from the trial, are there any more results forthcoming and what are the next steps?
Yes, we want to do… I will be presenting here the results of somewhat more than 400 patients. We plan to extend this experience and we want to do a more deep analysis of the results based on characteristics such as age, time to transplant, also conditioning regimens so more results are going to come in the next future.
I think that only to say that the landscape of AML therapy is evolving, that probably it will need a combination of conventional therapies, including transplantation, with novel approaches like targeted therapy and also immune therapies in order to improve the results. But also a positive message is that I mentioned almost 40% of AML patients who get a remission may be cured without the need of an allogeneic transplant in first complete remission. Patients in the favourable genetic categories have an event free survival above 60% with chemotherapy only. So that is very important, it’s different to what happened in the past.
