CLINICAL NEWS
Time to Reconsider Allogeneic SCT in NPM1Mutant AML?
TABLE.
Allogeneic stem cell transplantation (SCT) significantly improved
rates of relapse-free survival
(RFS), but not overall survival
(OS), in patients with acute myeloid leukemia (AML) who also
harbored a mutated nucleophosmin-1 gene (NPM1), according
to results recently reported in the
Journal of Clinical Oncology.
NPM1 mutations, which are
present in a large percentage of
patients with AML who have a
normal karyotype, are considered
a favorable prognostic marker and
are associated with improved outcomes and remission rates. While
patients with high-risk profiles are
typically referred for transplantation, patients with more favorable
risk profiles, such as those with
NPM1-mutant AML, are more
likely to receive chemotherapy
alone. So, should NPM1-mutant
AML patients be referred for
allogeneic SCT or chemotherapy
alone as post-remission therapy?
In this donor versus no-donor
analysis, lead author Christopher
Röllig, MD, from University Hospital Dresden in Germany, and
colleagues compared the clinical
courses of patients with NPM1mutant AML who were eligible
for allogeneic SCT to assess its
predictive value.
ing clinically relevant bleeding,
versus 8 percent (6 of 72 patients) of
the enoxaparin group.
“Our observation that the 300-mg
dose regimen of FXI-ASO markedly
reduced the rate of venous thrombosis, as compared with enoxaparin,
and that any clots that formed were
small, raises the possibility that
factor XI may be involved not only
in the propagation of thrombosis,
but also in its initiation,” researchers
wrote in their NEJM paper. These
findings challenge “the concept that
tissue factor is the main driver of
thrombosis among patients undergoing surgery.”
The ability to dissociate thrombosis and hemostasis is “the Holy
Grail” of anticoagulant therapy, Dr.
Büller said, and has the opportunity
to revolutionize surgical care and
reduce medical costs. ●
References
• Büller HR, Bethune C, Bhanot S, et al. Factor XI antisense
oligonucleotid