Trasplante de médula ósea en leucemia Mieloide Aguda- Dr. Fernando Barroso Duarte

TRASPLANTE DE PROGENITORES HEMATOPOYÉTICOS EN LEUCEMIA MIELOIDE AGUDA Fernando Barroso Duarte UNIVERSIDADE FEDERAL DO CEARÁ HOSPITAL UNIVERSITÁRIO WALTER CANTÍDIO HEMOCE

Conflito de Interesses De acordo com a resolução do Conselho Federal de Medicina nº 1595/2000 e Resolução da Diretoria Colegiada da ANVISA nº 96/2008, eu declaro que: Pesquisa Clínica – como Investigador: Sanofi, Jansen e Novartis Apresentações científicas – como Palestrante: Sanofi e Novartis Atividades de Consultoria – como Membro de Advisory Boards: não

Declaro não ter ações em bolsa de valores das empresas supracitadas.

Meus pré-requisitos para participar destas atividades são o intercâmbio científico, a autonomia do pensamento científico, independência de opinião e liberdade de expressão, aspectos estes respeitados pela Novartis.

Introduction • Allogeneic Hematopoietic Cell Transplantation (alloHCT) with its pretransplantation cytoreductive conditioning and the immunologic antileukemic graft-versus-leukemia (GvL) effect provides the strongest antineoplastic therapy currently available in acute myeloid leukemia (AML) • By using allo-HCT even a significant (20-30%) proportion of patients whith chemotherapy resistant AML can be cured underlining the enormous potential of the immunologic GvL effect Dohner H, Weisdorf D, Bloomfield CD. N Engl J Med. 2015; 373 (12); 1136-52.

Dombret H, Gardin C. Blood. 2016; 127 (1): 53-61.

Comelissen J, Blaise D. Blood. 2016; 127 (1): 62-70.

Craddock C, et al. Leukemia.2011; 25 (5): 808-13.

Introduction • Allo-HCT is associated with substantial morbidity and mortality and compared to chemotherapy may heavily negatively impact physical and social functioning as well as quality of life on short but also on the long term • The recommendation for na allo-HCT as preferred therapeutic option should therefore be based on solid clinical data using appropriated statistical methods and a careful information of patients and their families about the risks and consequences of allo-HCT Watson M, et al. Eur J Cancer 2004; 40:971-978.

Messerer D, et al. Haematologica 2008; 93 (6): 826-833.

Introduction • Although a growing number of distinct AML subsets have been increasingly characterized, patient management has remained disappointingly uniform • If one excludes acute promyelocytic leukemia, current AML management still relies largely on intensive chemotherapy and allogeneic hematopoietic stem cell transplantation (HSCT) • At least in younger patients who can tolerate such intensive treatments

• Improved identification of patients at relatively low risk of relapse should limit their undue exposure to the risks of HSCT in first remission

Dombret, Hervé, and Claude Gardin. Blood 127.1 (2016): 53-61.

Introduction • The role of new effective agents, such as purine analogs or gemtuzumab ozogamicin, is still under investigation, whereas promising new targeted agents are under clinical development • Minimal advances have been made for patients unable to tolerate intensive treatment, mostly representing older patients • Hypomethylating agents • More efficient combinations with novel agents

Dombret, Hervé, and Claude Gardin. Blood 127.1 (2016): 53-61.

HUWC/UFC E HEMOCE