Aref Al-Kali, MD
For patients with acute myeloid leukemia (AML), emerging regimens are likely to have a significant impact on clinical practice, according to Aref Al-Kali, MD.
State of the Science Summit on Hematologic Malignancies. In an interview, he discussed some of the recent advancements, exciting ongoing trials, and the largest unanswered questions.
OncLive: Can you provide an overview of your presentation on AML?
We talked about the standard regimens, practice, and the new trials and new drugs [coming down the pipeline] in AML. We talked about some of the changes that have been happening in the management of AML, in both adult and elderly patients. Specifically, we talked about some of the new data—about the differences between daunorubicin at 90 mg/m2
versus 45 mg/m2
and 60 mg/m2
. We talked about some of the changes coming to the NCCN guidelines showing that both the 90 mg/m2
and 60 mg/m2
approaches are acceptable.
There were also exciting results about a new combination with a new formula called CPX-351. With this liposomal formula, it seems that the response is better and the toxicity is less, specifically in elderly patients with AML. There was a phase III study that was presented at the 2016 ASCO Annual Meeting, and more results were presented at the 2016 ASH Annual Meeting. All of that supports that the combination seems to be very effective, especially in these elderly patients who have high-risk features by being secondary AML or have genetic abnormalities predicting that they will be not good candidates for standard chemotherapy. In this trial, the responses were better, the mortality was less, and the survival was potentially better than 7+3—even in the patients who proceeded with stem cell transplantation.
What does FLT3 tell us about prognosis and how it affects treatment decisions?
We do know that the prognostic risks for any acute leukemia depend on both the patient and the disease itself. For the acute leukemia itself, FLT3
is a marker that is present on our blood cells; however, it could be abnormal or mutated in patients with AML. This is usually abnormal in about 1 of every 3 patients. If that mutation is present, we know that the presentation tends to be a bit more aggressive, patients tend to have higher white cells, and they have a higher chance for relapse.
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