Role of Transplant Eligibility in Treating Secondary AML

Eunice S. Wang, MD, chief of the Leukemia Service at Roswell Park Comprehensive Cancer Center, discusses the role of transplant eligibility in shaping treatment strategies for secondary acute myeloid leukemia (AML).

Wang emphasizes the importance of considering allogeneic stem cell transplantation for patients with pre-existing bone marrow damage and those who have received extensive prior therapy. These patients, she explains, are unlikely to be cured with further chemotherapy, making early transplantation a critical option.

While transplant was previously not recommended for older patients due to the high risk of acute graft-vs-host disease, advancements in technology and newer drugs have helped mitigate these risks. As a result, allogeneic stem cell transplantation is increasingly being offered to older patients and those without a donor match.

Transcription:

0:10 | It is really important to look at transplant strategies, [especially for patients with] pre-existing damaged bone marrow who have undergone significant prior therapy. These patients are unlikely to be cured with additional cytotoxic chemotherapy alone. The sooner we can get them to an allogeneic stem cell transplant, the better. I think this is a critical point to think about.

0:36 | We also, in the past, had not been recommending that patients go to allogeneic stem cell transplantation due to the high risk, especially in older patients, of developing acute graft-vs-host disease. This is a complication where the donor’s cells attack the host's cells, leading to potential organ failure. However, we now have newer technologies and drugs that help mitigate the high mortality and morbidity associated with acute graft-vs-host disease.

1:08 | So, we are now increasingly able to offer allogeneic stem cell transplantation to older patients and those who, in the past, did not have available donors. We encourage people to consider this option for patients with poor prognosis acute leukemias, including this particular subtype.