MedicalResearch.com Interview with:
Huisheng Ai, MD, Director
Department of Hematology and Transplantation,
Affiliated Hospital of the Academy of Military Medical Sciences,
MedicalResearch.com: Which of these results did you find most interesting or surprising?
Response: First, we must stress that microtransplant dramatically improved the outcome of older patients with AML.
As we know, older AML patients often possess unfavorable prognostic factors, organ dysfunction, and slow post-chemotherapy hematopoietic recovery. Therefore, the general treatment outcome is unsatisfactory even though the incidence is increasing by age with low complete remission (CR) rates (34% to 65%) and poor short-term survival (Two years overall survival was about 11% to 25%).
This study involved cases from multiple centers of China, USA and Spain, and found that microtransplant could not only significantly improve complete remission rate in older AML patients among all age groups from 60 to 85, but also improve 1-year and 2-year overall survival and disease free survival especially in patients aged 60 to 75. Second, microtransplant completely overcomes the restriction of HLA typing. The donor could be the patient’s haploidentical family member, or unrelated and fully mismatched one. The incidence of graft-versus-host disease (GVHD) was only 1.1%, even if no any GVHD prevention was given. Other treatment related complications and mortality were also decreased.
These results are much better than those of traditional chemotherapy, myeloablative and non-myeloablative transplant, which provides a more safe and effective treatment choice. We are looking forward to seeing the revision of NCCN guideline for older AML to make microtransplant benefit more older patients.
MedicalResearch.com: Which patients with AML would be ideally suited for MST?
Response: As we said above, older AML patients are definitely the most suitable cases to receive microtransplant. Also, young adult patients in low- or intermediate-risk group without suitable HLA matched donors could also benefit from microtransplant.
We have compared HLA mismatched microtransplant with HLA matched non-myeloablative transplant for treating young adult AML patients, and found that in the microtransplant group, the relapse rate of microtransplant was slightly high, however, the non-relapse mortality was significantly lower, and with comparable overall survival (OS) and leukemia free survival (LFS).
Others included that microtransplant improved life quality and reduced cost.
MedicalResearch.com: What main message would you hope for physicians to take away from this report?
Response: We advocate doctors to pay more attention to the treatment of older AML patients, and underline that older AML patients could achieve the same or nearly complete remission rate with young adult patients if properly treated. We also suggest to complete 2 or 3 post-remission consolidation chemotherapy as far as possible with the aim of acquiring more long-term survival. In addition, we also suggest that doctors and NCCN guideline makers reduce or abandon decisions like supportive care only or low dose chemotherapy to older AML patients. These patients also have privilege and opportunity to get better long-term survival.
MedicalResearch.com: What other points would you like to make?
Response: Except for AML, microtransplant has also been successfully utilized to treat myelodysplastic syndrome and refractory lymphoma. Several centers including ours have also extended microtransplant to treat multiple myeloma and some solid tumors, but not verified by large sample studies. In addition, while it is considered as a novel, safe and effective leukemia-treating pattern, microtransplant also represent a novel concept of hematopoietic stem cell transplant, especially those that the mechanisms of microtransplant to induce graft-versus-leukemia and recipient-versus-leukemia effects are still need to be further elucidated. We are looking forward to sharing more clinical and mechanistic study outcome of microtransplant with scientists worldwide.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Guo M, Chao NJ, Li J, Rizzieri DA, Sun Q, Mohrbacher A, Krakow EF, Sun W, Shen X, Zhan X, Wu D, Liu L, Wang J, Zhou M, Yang L, Bao Y, Dong Z, Cai B, Hu K, Yu C, Qiao J, Zuo H, Huang Y, Sung AD, Qiao J, Liu Z, Liu T, Yao B, Zhao H, Qian S, Liu W, Forés R, Duarte RF, Ai H, for the Microtransplantation Interest Group. HLA-Mismatched Microtransplant in Older Patients Newly Diagnosed With Acute Myeloid LeukemiaResults From the Microtransplantation Interest Group. JAMA Oncol. Published online September 14, 2017. doi:10.1001/jamaoncol.2017.2656
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