Getting off the drugs: Tapering immunosuppressive agents after transplant in patients with advanced acute myeloid leukemia

This study aimed to investigate the effect of early tapering of immunosuppressive agents after stem cell transplants in patients with acute myeloid leukemia.

This study concluded that early tapering of immunosuppressive agents after stem fell transplants in these patients can improve survival.

Allogeneic hematopoietic stem cell transplant (alloHSCT) is a common treatment option for patients with acute myeloid leukemia (AML). Patients who undergo alloHSCT are given immunosuppressive drugs before and after the transplant to ensure it is successful. These immunosuppressive agents are tapered (gradually lessen the amount) after alloHSCT. It is thought that if the tapering occurs early after alloHSCT that this may reduce the risk of relapse (cancer returning) and improve survival.

It was not known if early tapering of immunosuppressive agents after allo-HSCT would influence the survival and the risk of relapse.

This study involved 63 patients who had AML. 31 patients had advanced AML and received early tapering of immunosuppressive drugs after allo-HSCT. 32 patients had AML and were in complete remission (CR) and received routine tapering of immunosuppressive drugs after allo-HSCT. 24 months after transplantation several outcomes were measured.

The relapse incidences were 22% for the advanced group compared to 16% for the CR group. Disease free survival (DFS, time from treatment until death due to AML) was 57.7% for the advanced group compared to 66.6% for the CR group. The overall survival (OS, time from treatment until death from any cause) was 57.8% for the advanced group compared to 66.2% for the CR group.

Two-year immunosuppressive agent-free DFS (IDFS) was 48% for the advanced group and 51.3% for the CR group. Graft versus host disease (GvHD) is a complication of alloHSCT where the transplanted cells attack the body’s cells. The incidence of acute GvHD (aGvHD) was similar between the two groups. The incidence of chronic GvHD (cGvHD) was 70.4% in the advanced group compared to 38.7% in the CR group.  

This study concluded that advanced AML patients treated with allo-HSCT who undergo early tapering of immunosuppressive agents could have improved survival without significant side effects. 

Consult your physician about tapering of immunosuppressive agents after allo-HSCT.