Optimizing Decision-Making on Transplantation for Patients With AML
At the 2026 LL&M Winter Symposium, Jeffrey Lancet, MD, Moffitt Cancer Center, Tampa, Florida discussed the latest clinical insights into determining which patients with acute myeloid leukemia (AML) should be recommended for transplant.
Transcript:
I'm Jeff Lancet from the Moffitt Cancer Center in Tampa, Florida. I am here at the LL&M Winter Symposium on Hematologic Malignancies. I was asked to speak today about how to optimize decision-making for transplant in AML.
I feel that there are some critical components to determining transplant eligibility amongst AML patients. Those critical components for eligibility relate to underlying disease biology and measurable residual disease (MRD) status. We recognize that not all patients within each disease biology risk category are the same and that many of them will do well or poorly no matter what you do, but there are some important considerations.
With respect to very adverse disease biology as characterized by biallelic TP53, we need to recognize that these patients do very poorly after transplant, and that our efforts should be focused on improving disease-modifying therapies before transplant and trying to focus on clinical trials to improve these outcomes as a priority. For other groups, we recognize that MRD status prior to transplant is certainly very important and can play a role, particularly in patients with favorable- or intermediate-risk disease.
Within the context of intermediate- and favorable-risk disease, MRD negativity can be an important consideration for not doing a bone marrow transplant, whereas MRD positivity can be considered an important consideration for pursuing a bone marrow transplant, because of the fact that bone marrow transplant can rescue and result in prolonged survival amongst MRD positive patients at the time of transplant.
And then finally, we often have the question about what is the best bridge to a transplant? What is the best pathway to get to a transplant? Do we need to intensively treat patients from the very beginning, or can we use less intensive therapy and still expect to move into a bone marrow transplant for those patients as well?
The emerging data strongly suggests that lower intensity therapy in the form of HMA plus venetoclax can result in significant numbers of patients achieving the ability to go through transplant and having successful transplant outcomes, so that we probably should be less concerned about the initial therapy as an important factor in determining who is actually eligible for transplant.
Those, I think, are the key factors in understanding the eligibility for transplant and the pathway towards transplant.
Source:
Lancet J. Who Should Be Transplanted in AML? Evolving Criteria and New Evidence. Presented at Lymphoma, Leukemia & Myeloma Winter Symposium; January 30-February 1, 2026 Amelia Island, Fl.
