At @ASH_hematology #ASH22 highlights I am being told some transplanters are refusing to do #AlloHSCT for otherwise eligible #AMLSm younger pts in CR because of bialleic #TP53 +MRD, I don’t think this is acceptable. Counsel on poor outcomes but there is a tail at end of OS curve
https://twitter.com/BrianShafferMD/status/1614310060452368386
Even if it 10%. I anecdotally had few pts who lived for years post transplant going in with TP53 bialleic complex type & MRD+ CR. I don’t think you should deprive pt only possibly of cure just to try to eradicate pre-allo MRD which often does not occur with any pre-transplant tx
Give MAC & throw in early maintenance & hope GVL effect kicks in before relapse. We have to be humble about how we council using data. Encourage trials of novel agents, counsel patients honestly, if older pt who can’t get MAC then maybe discourage transplant not in younger pt
For an #AMLsm patient who is 58 yr old with a donor & otherwise eligible for Allogeneic transplant & achieved CR with CPX-351 liposomal Ara-C/Daunorubicin but had persistent MRD with bialleic #TP53 /Complex karyotype after induction & no access to trial, what do you recommend?
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