Round Table Replay: AML Essentials, Here’s What You Need to Know, Part 2

This HealthTree Round Table for AML took place on February 13th, 2023 

Topic: AML Essentials, Here’s What You Need to Know (Part 2) 

Experts: Dr. Pamela Becker, City of Hope, Dr. Gabriel Mannis, Stanford, Dr. Dan Pollyea, University of Colorado

Part 2 - Developing a Personalized Treatment Strategy with Dr. Becker

Here's a recap of Dr. Becker's presentation  

Personalized information is determined based on the patient's goals of treatments and risk level. It is important to tailor every patient’s treatment so it can best contribute to a high quality of life.

Here are some questions you can ask your AML team:

• What are my options/alternatives?
• Is transplant an option for me or not? 
• What is special about my AML that can be leveraged for treatment?
• What is special about my medial history that limits my options?

Treatment overview

Intensive (7+3 or triple therapy) vs non-intensive treatment (hypomethylating agents + venetoclax)

• Initial treatment is NOT curative for the majority of patients
• There are risk groups based on genetic features: favorable, intermediate, and adverse. These are associated with response and survival

Some categories of AML can only be cured with a transplant

Types of donors:

• Related
• Matched sibling, children or parents 
• Haploidentical (half matched)
• Unrelated donor (cord blood, other people)

Types of transplant preparative regimens: 

• Myeloablative (wipes out the entire bone marrow)
• Reduced intensity = “mini” 

Types of medications often used during the transplant process:

• Tacrolimus/methotrexate
• Tacrolimus/sirolimus
• Post transplant Cyclophosphamide
• Cell manipulations like T-cell depletion

Risk

Risk stratification, according to European Leukemia Net (ELN) (the most frequently used classification system) is based on genetic abnormalities which are seen since the date of diagnosis. 

Risk can be classified as three levels: favorable, intermediate and adverse. All include diverse aberrancies that you can further see on Dr. Becker's slides in the video.

There are a bunch of different mutations in chromosomes for AML patients; the most common is FLT3, followed by NPM1, DNMT3A and NRAS. This is called heterogeneity. 

Research is aiming to improve tailored treatment, based on recent studies that are being conducted by specialists. The overall survival from a recent study from 2022, was 57%, which is encouraging. 

Some potentially targetable mutations are:

• FLT3
• NRAS
• TP53
• KRAS
• IDH1 and 2
• KIT
• SF3B1
• SRSF2

Prospective studies in a higher number of patients and a wider range of drugs and drug combinations are warranted to improve clinical predictability. Don’t forget to talk about clinical trials with your specialist!

Stay tuned

Part 3, Decision Making Strategies with Dr. Pollyea, will be published next week! 

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