This podcast discusses the state-of-the-art tools available to physicians to risk-stratify patients with acute myeloid leukemia (AML) in first complete remission (CR1). These tools can help differentiate between patients who may benefit most from hematopoietic cell transplantation (HCT) from those, who may benefit most from consolidation chemotherapy alone.
The discussion focuses on risk stratification for intermediate-risk patients, recognizing that poor-risk patients with AML in CR1 should generally be offered HCT and favorable-risk patients should be offered consolidation chemotherapy.
Although molecular genetics and cytogenetics have the most important influence for patients with intermediate-risk disease, the decision to recommend HCT also includes:
- Perceived or calculated risk of transplant-related mortality
- Detection of minimal residual disease (MRD)
- Patient age
Transplantation is recommended for many intermediate-risk patients; however, a patient with a FLT3-ITD mutation would be recommended a treatment with a FLT3 inhibitor. Similarly, the finding of an IDH2 mutation would suggest offering the patient a clinical trial with enasidenib in the up-front setting.
The presence of MRD should be considered when deciding whether or not a patient should proceed to transplant, and patients who are MRD positive should be offered additional consolidative treatments or other novel approaches, such as additional therapy with a targeted agent.
Using current risk stratification tools for patients with AML in CR1 can help clinicians, in consultation with their transplant colleagues, determine optimal treatment options for their patients.
Editor’s note: Transcripts of Blood Advances podcasts undergo the same peer-review process as all articles published in the journal.