The following is a summary of “Application of prophylactic or pre-emptive therapy after allogeneic transplantation for high-risk patients with t(8;21) acute myeloid leukemia,” published in the April 2023 issue of Hematology by Guo, et al.
For a retrospective study, researchers sought to assess the effect of pretransplant measurable residual disease (pre-MRD) before allogeneic hematopoietic cell transplantation (allo-HCT) and the effectiveness of maintenance therapy in patients with t(8;21) acute myeloid leukemia (AML).
The retrospective analysis covered 100 cases of allo-HCT-treated t(8;21) AML between 2013 and 2022. About 40 patients received preemptive therapy, including immunosuppressant titration, azacitidine, donor lymphocyte infusion (DLI), and chemotherapy. In addition, about 23 patients received azacitidine or chidamide as part of their preventative care.
Patients with a positive pre-MRD (pre-MRDpos) had a higher 3-year cumulative incidence of relapse (CIR) than those without (25.90% [95% CI, 13.87%-39.70%] vs. 5.00% [95% CI, 0.88%-15.01%]; P = 0.008), according to the study. Pre-MRDpos patients who still had positive MRD at 28 days after transplantation (post-MRD28pos) were less likely to have a superior 3-year disease-free survival (DFS) (40.83% [95% CI, 20.80%–80.16%]). The 3-year DFS and CIR for patients who underwent preventive treatments following molecular recurrence were 53.17% (95% CI, 38.31% – 73.80%) and 34.87% (95% CI, 18.84% – 51.44%), respectively. The 3-year DFS and CIR were 90.00% (95%CI, 77.77%- 100%) and 5.00% (95%CI, 0.31%- 21.10%) for high-risk patients receiving preventive treatment. The study found that epigenetic-drug-induced adverse events were mostly reversible with dose adjustment or temporary discontinuation.
According to the study, even after receiving preventive interventions, pre-MRDpos, and post-MRD28pos were more likely to experience higher rates of relapse and less favorable DFS. Prophylactic therapy might be a preferable choice for high-risk t(8;21) AML patients, but more research is required.
Source: tandfonline.com/doi/full/10.1080/16078454.2023.2205739