Transplant without salvage: cut out the middleman
Mené sur 281 patients atteints d'une leucémie myéloïde aiguë récidivante ou répondant peu au traitement d'induction, cet essai randomisé de phase III évalue la non-infériorité, du point de vue du taux de rémission complète, d'une chimiothérapie de sauvetage à base de hautes doses de cytarabine par rapport à une greffe allogénique de cellules souches dispensée immédiatement
In this issue of The Lancet Haematology, Matthias Stelljes and colleagues 1 present a compelling exploration of an approach to allogeneic haematopoietic stem-cell transplantation (HSCT) in patients at high risk of relapse or induction-refractory acute myeloid leukaemia. This concept is in stark contrast with the long-upheld orthodoxy of using varying regimens of salvage chemotherapy to induce remission or a morphological leukaemia-free state before transplantation. 2 These approaches, while considered to be the standard of care in most institutions, are associated with substantial morbidity, particularly when conventional chemotherapy is used. While disease control can indeed occur, it is at the cost of cumulative toxicity and can render patients no longer able to endure allogeneic HSCT. The response rates in leukaemia that have already shown some degree of resistance to conventional chemotherapy vary, ranging from 35% to 62%, however these remissions are short lived and are best considered a bridge to transplantation.