Opening their discussion on the management of acute myeloid leukemia (AML), expert oncologists provide an overview on the incidence, diagnosis, and stratification of patients.
Jorge E. Cortes, MD: Hello, and welcome to this OncLive Peer Exchange titled, “Expert Perspectives on Current and Emerging Therapies for AML.” My name is Jorge Cortes. I’m the director of the Georgia Cancer Center at Augusta University in Augusta, Georgia. I’m joined today by a panel of experts in AML [acute myeloid leukemia]. I would like to welcome all my esteemed fellow panelist and I would like to ask them to introduce themselves. I will start with Dr Carraway, please.
Hetty E. Carraway, MD: Hi, everybody. My name is Dr Hetty Carraway. I’m the leukemia director at Cleveland Clinic in Cleveland, Ohio, and I’m delighted to be here and excited for our discussion.
Jorge E. Cortes, MD: Thank you. Dr Kasner?
Margaret T. Kasner, MD: Hi, I’m Dr Margie Kasner. I am the leukemia director at Thomas Jefferson in Philadelphia, and I’m looking forward to today.
Jorge E. Cortes, MD: And Dr Jonas?
Brian Andrew Jonas, MD, PhD: I’m Dr Brian Jonas. I’m at UC Davis, California, and I lead our leukemia program, both clinical and research.
Jorge E. Cortes, MD: Thank you, and welcome everyone. Thank you again for joining us in this program. Today we’re going to discuss several recent updates in the treatment of acute myeloid leukemia with a focus on what has been presented at key conferences in this year 2022. We will discuss the data and put it in the context of the guidelines and the treatment landscape, and our own clinical practice and how it impacts some of what we’ve been doing so far. First, we’re going to do a quick overview of acute myeloid leukemia. Acute myeloid leukemias represent a relatively small percentage of all cancers; it’s about 1% of all cancers in the United States. It is estimated that in 2022, approximately 20,000 individuals will be diagnosed with acute leukemia. And there’ll be approximately 11,000 to 11,500 deaths from acute myeloid leukemia in 2022; that represents about 1.9% of all cancer-related deaths. The relative incidents of AML have not changed much over the years but the relative survival has somewhat improved over the years. Right now, the estimated 5-year relative survival is about 30%. There is not much of a difference in the relative survival or in the relative mortality. Over the years, the incidents and survival are both somewhat higher in men than in women, and there is some difference in the survival rate according to different races, and that’s an important topic that has led to much discussion in access to clinical care. But we don’t have much time to address that at this moment. One important recent change has been the awareness of the molecular complexity of acute myeloid leukemia. When we talk about acute myeloid leukemia nowadays, we’re no longer talking about 1 disease, but many diseases. We’ve evolved from the old FAB [French-American-British] classification that some of us are old enough to remember from M1 to M7, eventually we added M0. We no longer use that classification, but we are talking more about the cytogenetics and the molecular complexities. I’d like to ask our panel, how have you incorporated that molecular classification and that cytogenetic, and put it all together into your practice today? First, Dr Carraway, how are you doing this in your practice? How do you incorporate this into your treatment algorithms?
Hetty E. Carraway, MD: When we think about our patients with AML, the standard approach to our patients and their workup includes evaluating their complete blood count and obtaining a bone marrow biopsy with aspirate, and that aspirate helps us to collect information such as flow cytometry and chromosome analysis, as well as next-generation sequencing. It is a central part of setting up a patient’s next steps in terms of their therapy. For example, the results from the next-generation sequencing can inform and help us understand the risk profile that a patient may have. We are often challenged by waiting for some of those results, but in our patients that are older and have white count that’s in an unmanageable state, we can wait for the information for comprehensive cytogenetics, the FISH [fluorescence in situ hybridization] testing, as well as the next-generation sequencing. This can help us profile patients as to whether they’re in a favorable-risk category, or an intermediate-risk category/adverse-risk category. This is important because we need to have these conversations with our patients and their loved ones, regarding the likelihood of benefit of intensive therapy and the outcomes that they should expect with the treatments moving forward. It’s important to have these discussions with patients because as you alluded to and reviewed, the outcomes for our patients, although they’re somewhat better than in years past, still aren’t what we hope they should be. I imagine that Dr Kasner will be able to highlight some of that, especially with our expertise in the older patient population where we must have these conversations with them. If we have patients that have a core-binding factor cytogenetic abnormality, we are hopeful that they’re sensitive to cytarabine-based therapy. We have novel therapies with targeted agents that we’ll be talking about today, and we also have agents, such as venetoclax [Venclexta] in combination with azacitidine [Vidaza], that we’ll be walking through. Some of the challenges in our older patient population include the fact that many of the leukemias are not de novo, but rather a secondary or an emerging AML from an underlying antecedent hematologic malignancy. For those patients, we worry that their outcomes will not be enduring with a chemotherapy-only based approach, and we must balance that with the morbidity and mortality of transplants. I’m eagerly interested in the comments from our colleagues today and what thoughts the group has today to talk about.
Transcript edited for clarity.