This HealthTree Round Table for AML took place on September 17th, 2022.
Topic: Decision Making in AML: What's Next After Relapse?
Experts: Dr. Eunice Wang and Dr. Amanda Przespolewski from Roswell Park Cancer Center in Buffalo, NY, Dr. Lourdes Mendez from Yale Cancer Center and Dr. Jane Liesveld from Rochester University in Rochester, NY
Acute Myeloid Leukemia (AML)
— Disease of older adults
— Biologically diverse
— Clinically aggressive
It is important to know your specific type of AML.
Pathway to a cure: Intensive chemotherapy
Diagnosis — [INDUCTION] — Complete response (CR) — [CONSOLIDATION] — CR— [MAINTENANCE/TRANSPLANT] — Cure
What is MRD? This means minimal residual disease. It is residual leukemia not detected by morphology (<5% blasts)
How is MRD detected?
When should we test for MRD? Whenever you get a treatment change.
Some insights regarding MRD:
The amount of disease burden prior to transplant is measured by your MRD status.
MRD needs to be measured prior to and after bone marrow transplantation.
Being MRD positive is related to post-transplant relapse
There is a study going on for prevention of post-transplant relapse. The SORMAIN study is evaluating “sorafenib” which is a FLT3 inhibitor
Other options to prevent relapse currently being tested in clinical trials are:
Treatment of post-transplant relapse:
There are approximately 258 studies listed for relapsed/refractory AML
Phases of clinical trials:
There are different kinds of trials:
Is there something influencing the decision to participate?
Motivation is very personal and private
Benefits obtained from enrolling
Altruism — research is the BEST way to help science!
Vulnerability in elderly or frail patients, or patients with comorbidities
Some questions to ask yourself:
Barriers for patients:
The likelihood a drug would pass all phases of clinical testing and get FDA approval was 7% for AML. Right now this number is a little bit higher.
COVID: There are no contraindications to COVID-19 vaccination while on trials
The fear of recurrence or progression (FCR) is a common concern, and it can potentially affect quality of life. This interferes with medical care.
People who are especially vulnerable to FCR include:
Wellness is key in this pathology, this is tied to interwoven elements of life. This is individual:
EMOTIONAL — INTELLECTUAL — PHYSICAL — SPIRITUAL
Matching care and FCR depends on its intensity:
MILD FCR: Self-help
MODERATE FCR: Peer support
SEVERE FCR: Pharmacotherapy and psychological counseling
Peer support includes:
One-on-one support: mentoring
*Imerman Angels is a cancer support community for this.
One-on-one support: Counseling
Psychological care is recommended — cognitive therapy and counseling are part of the treatment.
SUMMARY & GUIDING POINTS
1.- (0:34) Are there any existing data or clinical trials for MRD regarding the RUNX1 mutation?
2.- (2:50) What are the four MRD testing options?
3.- (6:00) Does MRD show up before relapse, what about post-transplant?
4.- (6:45) How often should you test MRD if you are in remission?
5.- (8:17) Do you have any tips for people undergoing clinical trials? How can you make that process a little bit easier?
6.- (10:00) Do you have any information on CAR-T cell therapy for AML?
7.- (11:30) If someone relapses after transplant, even with maintenance, with certain genetics, what is your advice?
8.- (14:12) What about the use of marijuana to deal with pain and anxiety?
about the author
Andrea Robles is an International Medical Graduate, part of Healthtree’s patient navigator staff. She is committed to patient’s global wellness and finding a cure through research. She’s also a wife and mom of 3.