AlloHSCT in AML: When, Why, and for Whom?

Summary for Physicians:

In the discussion between Dr Gandhi and Dr Bejanyan, the focus is on identifying appropriate candidates with AML for alloHSCT. Dr Bejanyan emphasizes that alloHSCT is typically considered for patients with AML who are in complete remission but are at intermediate or poor risk of relapse.

Key disease-related factors influencing the decision include the following:

• Cytogenetics and molecular markers: Adverse cytogenetic abnormalities and unfavorable mutations (eg, FLT3-ITD, TP53) are classified as poor-risk features.
• Response to induction therapy: Patients with incomplete response or minimal residual disease positivity posttherapy are also considered higher risk.
• Risk classification: Risk is generally assessed using established criteria such as the ELN risk stratification system.

Overall, alloHSCT is pursued in patients for whom the potential benefit in relapse prevention outweighs the risks of transplant-related morbidity and mortality.

Nelli Bejanyan reports consulting or advisory role for CareDx, Medexus Pharmaceuticals, Orca Biosystems, AlloVir, TScan Therapeutics, and Pfizer; and research funding from CRISPR Therapeutics. Everett Meyer reports sponsored research from Orca Biosciences, Kyverna; and a scientific advisor role and equity holder for GigaMune, Indee, TRACT, Jura Biosciences.Caspian Oliai reports no relevant disclosures (investigator on the Orca T trial funded by Orca Biosciences). Arpita P. Gandhi reports roles with OncLive, MJH Life Sciences, OrcaBio (research), CareDx (Advisory Board). Amandeep Salhotra reports received funding from Rigel, Bristol Myers Squibb and Orca Biosciences; and speakers bureau for Incyte and Sanofi.