Q2 2023: Additional information and data in acute leukemia

AML

Ipilimumab plus decitabine for patients with MDS or AML in posttransplant or transplant-naïve settings: combination IPI + DEC treatment has an acceptable safety profile and has meaningful clinical activity in patients with R/R MDS/AML that does not appear to require T cell–mediated alloreactivity. IPI + DEC treatment may serve as a less-intensive bridge to transplant among potential transplant candidates. Future studies are warranted to identify rational IPI-based treatment strategies to generate prolonged responses without severe immune toxicity. (Ref: https://doi.org/10.1182/blood.2022017686)

ALL

Haploidentical hematopoietic cell transplantation with posttransplant cyclophosphamide (PTCy) graft-versus-host-disease (GVHD) prophylaxis yields a similar OS to HLA-matched unrelated donor (MUD) HCT with conventional prophylaxis. A study showed that despite a higher risk of relapse, younger donor haploidentical HCT with PTCy prophylaxis may be preferred over older MUD HCT with conventional prophylaxis in patients with ALL due to lower NRM and better OS. Further analysis comparing the effect of donor age in haploidentical PTCy vs MUD PTCy is warranted. (Ref. https://doi.org/10.1182/bloodadvances.2022009240)

To determine the prognostic significance of central nervous system leukemic involvement in newly diagnosed T-cell T-ALL, outcomes on consecutive, phase 3 clinical trials were examined. (Ref: https://doi.org/10.1182/blood.2022018653)

Key findings:

• Patients with CNS-1 and CNS-2 status have similar outcomes across 2 large studies with divergent therapies, including with and without CRT.
• Patients with CNS-3 T-ALL treated with nelarabine had similar OS as CNS-1 and CNS-2, and thus should receive nelarabine as standard of care.