In double cord blood transplantation, one unit engrafts and the other is rejected—but the losing unit might be doing more than previously imagined. A 2025 Blood Advances study from the Eurocord–EBMT registry reveals how the immunological battle between cord units can be redirected against leukaemia, particularly when the patient and losing unit share the right HLA mismatches. In this episode, we unpack the elegant biology behind this unintended vaccine effect, explore the surprising lack of excess GVHD, and consider what these findings mean for unit selection in high-risk disease. Could the losing graft be the key to preventing relapse?

Episode Type: Deep dive intended for leukaemia and transplant health care professionals

Reference:

Wynn R, et al. Impact of shared HLA determinants between patient and losing cord blood unit on relapse after double cord blood transplantation. Blood Adv. 2025 May 2:bloodadvances.2025015938. doi: 10.1182/bloodadvances.2025015938. Epub ahead of print. PMID: 40315369.

Which children and young adults with acute myeloid leukaemia should receive transplant in first remission? This episode explores a landmark 2025 analysis from the Children's Oncology Group that revisits this longstanding question through a contemporary molecular lens.

Huang and colleagues, publishing in the Journal of Clinical Oncology, analysed outcomes for over 1,400 patients from the AAML0531 and AAML1031 trials—studies that enrolled patients up to age 29. By retrospectively applying contemporary molecular risk criteria from the current AAML1831 trial, including newly recognised adverse genetic lesions and measurable residual disease thresholds, they revealed striking patterns in transplant benefit across redefined risk groups.

We unpack how this molecular reclassification informs our understanding of transplant outcomes, from the substantial improvements in disease-free survival for most high-risk patients to the unexpected findings in certain subgroups like monosomy 7. Along the way, we explore what these retrospective insights might mean for clinical practice in the genomic era of AML management—from approaches to molecular profiling at diagnosis to considerations around transplant timing in first remission.

Episode type: Deep Dive—intended for leukaemia and transplant health care professionals or scientists involved in AML diagnostics or research.

Reference: Hematopoietic Stem Cell Transplantation Outcomes for High-Risk AML: A Report From the Children’s Oncology Group by Huang BJ et al., Journal of Clinical Oncology, 2025. DOI: 10.1200/JCO-24-01841

Which children and young adults with acute myeloid leukaemia should receive transplant in first remission? In this Rapid Review, we explore a landmark analysis by Huang et al., published in the Journal of Clinical Oncology in April 2025. Reclassifying over 1,400 patients using AAML1831 criteria, the study offers a contemporary perspective on who gains from transplant—and who doesn't. The results are compelling: disease-free survival doubles for most molecularly defined high-risk patients, while those with monosomy 7 or 5 continue to fare poorly despite transplant. This three-minute overview highlights key findings and clinical implications, including donor timing, MRD integration, and the future role of targeted agents. The over-arching message is clear—biology now defines benefit.

Episode type: Rapid Review of a key paper for anyone interested in AML biology or treatment

Reference: Hematopoietic Stem Cell Transplantation Outcomes for High-Risk AML: A Report From the Children’s Oncology Group by Huang BJ et al., Journal of Clinical Oncology, 2025. DOI: 10.1200/JCO-24-01841