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Outcomes of a lately printed long-term follow-up of the ASAP trial, which was carried out at universities and clinics throughout Germany, present that the genetic threat of illness, not remission standing, determines total survival of sufferers with high-risk acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Moreover, there isn’t any advantage of remission induction with customary salvage chemotherapy previous to allo-HSCT.
The collection of sufferers for allo-HSCT and the very best method to bridging sufferers to transplantation is repeatedly mentioned by specialists. The primary outcomes of the ASAP examine (ASAP standing for “as soon as possible”), printed in 2024, have already attracted appreciable consideration.
ASAP questions current therapy requirements for AML and was the primary randomized managed trial to check remission induction with salvage chemotherapy previous to allo-HSCT—which represents the present customary of care (SOC)—in opposition to another method of fast transplantation after intensified conditioning mixed with non-intensive illness management methods comparable to much less aggressive chemotherapy or easy monitoring of leukemic proliferation. These two teams are known as the SOC arm and the choice therapy arm, respectively.
ASAP: Transplantation as quickly as attainable
The long-term evaluation, now printed within the journal Blood, helps the preliminary outcomes of the ASAP trial. The findings counsel {that a} transplantation as quickly as attainable yields comparable therapy outcomes as remission induction—with shorter hospital stays and decreased publicity to chemotherapy.
“The results question the international standard of leukemia treatment. We no longer need to give all patients a very aggressive chemotherapy to reduce the tumor burden ahead of transplantation when regimens with good anti-leukemic activity are used for conditioning on the days prior to stem cell transplantation,” says Prof. Dr. Johannes Schetelig, co-author of the examine.
The outcomes have been based mostly on a median follow-up of 61 months within the affected person cohort: The induction of remission within the SOC arm (5-year OS: 47.5%) in comparison with fast transplantation within the different therapy arm (5-year OS: 46.1%) confirmed no total survival (OS) benefit in AML sufferers, which have been poorly attentive to preliminary therapy or with untreated relapse.
Since non-inferiority couldn’t be demonstrated formally, fast transplantation is not going to change the frequent SOC however might be thought-about extra usually at the moment.
One argument in favor of continuing on to transplantation with out remission induction is that sufferers who acquired intensive salvage chemotherapy within the SOC arm spent one month longer in hospital and skilled extra hostile occasions.
Age and AML genetics are an important threat components influencing survival
The long-term follow-up of ASAP moreover analyzed therapy success based on threat classification and genetic subgroups. Each age and AML genetics have been recognized as an important baseline threat components influencing survival. AML genetics have been categorized based on the ELN 2022 standards.
The general survival possibilities at 5 years (5-year OS) from randomization within the totally different threat teams impartial from therapy arm have been:
66% with favorable threat AML,
53% with intermediate threat AML, and
34% for hostile threat AML.
When each the ELN threat and the therapy have been taken into consideration, the 3-year total survival was 77% for sufferers with favorable/intermediate AML with watchful ready within the different therapy arm (N = 49) versus 66% for sufferers transplanted with full remission within the SOC arm in the identical threat group (N = 49).
An essential step towards precision drugs in transplantation
“In summary, it can be concluded that survival after allo-HSCT in AML patients is less influenced by remission induction or bridging strategies and more influenced by intrinsic disease biology,” concludes Prof. Schetelig. Curiously, decreasing the pre-transplant leukemia burden didn’t translate into improved survival when intensive cytotoxic regimens have been used, difficult a typical assumption in therapy planning.
The unsure advantages of inducing remission previous to allo-HSCT are in distinction to the elemental affect of AML genetics. Favorable threat AML was related to larger survival charges in comparison with hostile threat AML. These findings are in step with earlier studies on the prognostic affect of the ELN 2022 classification in sufferers present process allogeneic stem cell transplantation.
“But the data of the ASAP trial also demonstrate that tolerable novel bridging therapies and posttransplant maintenance for more personalized strategies are urgently warranted, especially for adverse risk AML, to improve outcomes after allo-HSCT,” summarizes Prof. Schetelig.
“These findings open the door for future research to identify specific AML subgroups—a key step toward precision medicine in transplantation.”
Extra data:
Matthias Stelljes et al, Illness threat however not remission standing determines transplant outcomes in AML: long-term outcomes of the ASAP trial, Blood (2025). DOI: 10.1182/blood.2025028730
Journal data:
Blood
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Lengthy-term evaluation finds illness threat, not remission standing, determines transplant outcomes in acute myeloid leukemia (2025, October 6)
retrieved 6 October 2025
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