Jaime A. Suarez-Londono, MD, a medical oncologist at NYU Langone’s Perlmutter Cancer Center and Assistant Professor of Medicine at NYU Grossman School of Medicine, said the results of the ASAP study provide a basis for discussion with the transplant team.

“The landscape of treatment of acute myeloid leukemia (AML) has seen great advances in recent years, with multiple agents recently approved—many of them oral—that have broadened the arsenal available to achieve remission, newly proposed risk stratification by the European LeukemiaNet, and initiatives for standardization of markers of measurable residual disease [MRD],” Dr. Suarez-Londono said.

Jaime A. Suarez-Londono, MD

“In spite of the aforementioned progress, relapsed/refractory AML remains a clinical challenge; it carries devastating outcomes and adds a significant burden to patients and families. Therefore, research endeavors in this area are of particular clinical utility. In this setting, allogeneic stem cell transplant remains the treatment of choice, by virtue of the graft-vs-leukemia effect, in eligible patients who have a stem cell donor,” he continued.

Significance of ASAP Trial

“The need to achieve complete remission before allogeneic stem cell transplant in the relapsed/refractory AML setting is not entirely clear, with some data showing the use of myeloablative conditioning may compensate for the positive MRD postinduction. The presentation by Dr. Stelljes and colleagues brings forth that question,” he said. Calling this “a well conducted and balanced, randomized phase III clinical trial, with a significant number of patients,” he elaborated on these findings. “Not surprisingly, the complete response rate prior to transplantation was higher in the remission induction strategy arm [46%], but despite the higher rates of complete response in the remission induction strategy arm, the primary endpoint (complete response at day 56 after transplantation) was similar (84.1% in the disease control arm and 81.3% in the remission induction strategy arm),” he said. 

“What is more significant is the long follow-up and overall survival. At 1 and 3 years, overall survival rates remain virtually identical at 69.1% vs 71.9% and 51% vs 54.2% in the disease control and remission induction strategy arms, respectively. This clearly validates the use of sequential conditioning followed by allogeneic stem cell transplant, without the need for intensive remission induction chemotherapy, thus limiting toxicity, morbidity, and cost to the health-care system—and evidently having the potential to influence clinical practice,” he noted.

“Possibly the most important take-home message for oncologists who treat leukemias is to open a dialogue with their respective bone marrow transplant teams early on, in patients with relapsed/ refractory AML,” Dr. Suarez-Londono stated

DISCLOSURE: Dr. Suarez-Londono has received honoraria from AstraZeneca and Incyte.