Dr Jallouk on Preventing Post-Transplant Relapse in R/R Hematologic Malignancies

Andrew P. Jallouk, BS, MD, PhD, assistant professor, Vanderbilt University, discusses research evaluating potential post-transplant relapse prevention strategies in patients with relapsed/refractory hematologic malignancies.

Most retrospective data collected from prior research have demonstrated that deeper remissions correlate with better post-transplant outcomes for patients with hematologic malignancies, Jallouk says. Traditionally, transplant is provided to patients with low to nonexistent levels of detectable disease, Jallouk notes. However, novel minimal residual disease (MRD) detection techniques are changing the transplant paradigm, Jallouk emphasizes.

Studies conducted with clonoSEQ, an MRD detection technology used in patients with acute lymphoblastic leukemia (ALL), have demonstrated that MRD levels below a certain threshold do not typically affect transplant outcomes, according to Jallouk. These findings challenge the standard practice of establishing MRD negativity in patients prior to transplant. As further studies in this area are conducted, this body of research may alter the transplant eligibility criteria for patients with ALL, Jallouk says.

Furthermore, the phase 3 ASAP trial (NCT02461537), which was conducted in Europe, evaluated the efficacy of disease control prior to sequential conditioning and immediate allogeneic stem cell transplantation (n = 138) vs intensive remission induction chemotherapy followed by allogeneic stem cell transplantation (n = 134) in adult patients with relapsed acute myeloid leukemia (AML) or poor-responsive, nonfavorable AML after first induction therapy. The primary end point was complete response (CR) at day 56 after transplantation. In the intensive remission induction arm, 46% of patients achieved a CR.

The outcomes from the ASAP trial in AML were comparable with those seen with clonoSEQ in ALL, indicating that deep remissions may not be necessary for successful transplant, Jallouk emphasizes. Although inducing low levels of detectable disease prior to transplant remains the current standard of care, this practice may evolve as more data emerge, Jallouk concludes.