What are the newest drugs for relapsed/refractory AML? Which are some promising drugs in development?

What are the new drugs for relapsed refractory AML? Which are some promising drugs in development? So the question is what are the new drugs that are coming up, approved, or in the near horizon for patients with relapsed refractory, e.g. myelogenous leukemia? Some of the things that we are trying to do and not only us, many investigators across the globe are trying to do is can we combine some certain things that can be, that are already in the market? Say for that matter, can we add to the backbone of a hypometallic agent and venetoclax, right? In a more appropriate mutation context, if somebody has an IDH mutation, we can potentially add an IDH inhibitor. Those drugs are available. They are approved as single agent, but these are commercially available drugs. So you can potentially think about a triplet, right? For FLT3 mutations, you can add guilt or myelostrine. Again you can think about either combining that with chemotherapy or a backbone of a hypometallic agent and venetoclax. So now you can think of triplets. So that you can do with the existing options that are there, right? But then the other questions are what are in the horizon now, right? We are somewhat optimistic about drugs. Class of antibodies mostly targeting CD47 pathway. That's one of so-called not-it-me signal kind of pathway. At least early studies are exciting. Whether they truly pan out, we have to wait and see. The other class of drugs that are very, very exciting are so-called manin inhibitors. So the particular translocation happens involving the long arm of chromosome 11. And in that context, the manin inhibitors as a single agent are providing very high response rates. Now the durability, we'll have to wait and see. Whether in the long run do we need to add something else to these manin inhibitors to make the response last longer. That we'll have to see. But many of these patients, when they respond, now at least they are a candidate for a stem cell transplant. Whereas before, if they relapse, they were pretty much refractory to all of their treatments. So their chance of going for a stem cell transplant does not exist. So now in this new scenario for this particular patient with what we call the MLL gene rearrangement or chromosome 11 cure rearrangement, these patients are responding very well. Now other few groups of patients that are responding reasonably well to the manin inhibitors are patients with maybe RAN-X1 mutation or NPM1 mutation, the patients who have relapsed disease. So that's a lot of excitement in the community because it's a very targeted, very scientifically driven agent and it's delivering what it promised in the laboratory. The others are of course antibody drug conjugates. Either antibodies targeting CD123 or CD33 where we are combining that with like a payload, like a chemotherapy kind of a payload so that they can kill the cells that express this particular proteins on the surface. Now the other thing that we are also doing is trying to bring in the immune system into the treatment sphere, right, where the T cells or the immune cells are also engaged in fighting the leukemia cells. So what we call the bispecific T cell engagers are coming into the field. At least scientifically it's very exciting because you're not adding toxicity by adding a more intensive chemotherapy but using harnessing the immune system to fight. In the space of acute lymphoblastic leukemia or space of say non-Hodgkin's lymphoma, the strategies have been very, very successful. Been less successful in AML but again relatively it's new in the AML arena so we are very excited about that. We're finding of course the cellular therapies, CAR T cell therapies or CAR natural killer cell therapies that are coming up. We're very excited because particularly the natural killer cells, the chances of toxicities that we tend to see with CAR T cells, we tend not to see with natural killer cells. So that can open up a whole new field but these are very, very new and very emerging fields really.