Video
Once a patient reaches remission, how do doctors decide between monitoring for relapse or starting maintenance therapy?
Posted by
HealthTree Logo HealthTree
• July 10, 2023
Details
Description

Learn how doctors decide whether to monitor for relapse or begin maintenance therapy after a patient reaches remission in this video.

On this video
Transcript
So, in AML we have a risk calculation. So it's mainly based on the genetic abnormalities of the AML, the karyotype which we mentioned that's the chromosomal abnormalities and some mutational abnormalities that can place patients in one of three categories, either favorable risk, this would be about a quarter of patients would have actually a good prognostic leukemia AML that would pretend that they would respond very well to just chemotherapy alone and maybe most of those patients may be cured just by chemotherapy. Then there are some of the unfavorable ones we talked about. Those patients will not be cured by chemotherapy alone and we usually would recommend a stem cell transplant. That's another quarter of patients and actually most patients, 50% of patients fall in this intermediate risk and we use some of the genetic markers to stratify them then. So again this flip 3 ITD it's about a third of patients overall in AML will have that mutation and it's been shown in many studies that that is associated with a higher risk of relapse so those patients would be ones we may suggest, of the intermediate risk we might suggest a stem cell transplant. I would say the standard of care these days is to observe after remission induction and consolidation observe and especially like a favorable risk patient. That's still our standard I would say is to observe those patients for relapse. However if you had a higher risk of relapse that may be a patient again post the consolidation because we know that that's much better than just a maintenance strategy so getting the consolidation and then after that that would be a type of patient I might recommend to consider maintenance. Again even better if they can do it on a clinical trial that way we can compare it and learn from them. So usually when we're making a decision is actually even before patients make it to complete remission it's oftentimes when you get their early genetics and information of the characteristics of their disease. So acute leukemia can be set up in multiple buckets you know the favorable risk and then intermediate or less favorable patients or adverse risk patients. For favorable risk patients our goal really is to get them through a more intensive regimen and monitor them with surveillance clinical surveillance. But for the less favorable or the intermediate risk patients and anything above that if they are not able to complete a more intensive chemotherapy regimen followed by allogenic transplantation those are the folks who benefit the most from a maintenance regimen to date.

Related Content