What are some of the treatment strategies patients with acute myeloid leukemia should understand and be prepared for?

What are some of the treatment strategies patients with AML should understand and be prepared for? Usually when patients are diagnosed with AML, it just comes out of nowhere. And so we don't have all the information that diagnoses on a particular patient's AML, whether it's adverse risk AML or good risk AML. We don't always have that information in the beginning. So we don't talk that much about transplant early on. It's an option that may need to happen in the future. But first we need to get you into remission is how we typically have these conversations. And as we get more information, we'll talk more about subsequent options. So we talk about getting you into remission and the options typically are we're going to do induction chemotherapy with a 7 plus 3 or a typical regimen to that or the alternative, which is HMA, hypermethylating agent, and venetoclax. There are a few other options. Sometimes we can use targeted therapy. So if a particular patient with a particular type of AML, for example, a FLIT3, so if someone has a FLIT3 mutation, another drug is added to their induction chemotherapy with 7 and 3. So it's a lot of information up front. We tend to focus more on what's going to happen right now and then we'll talk more about what's going to happen in the future a little bit later on because it is a lot of information and it is completely overwhelming. I believe clinical trials is always a good option because AML is still a rare disease and we still don't have such great treatment options for patients. So 7 and 3 has been in use for decades and it still is a major treatment regimen that we use. And so we definitely want better treatments and the only way to get that is to do clinical trials. So for every patient, I think clinical trial is an option. So we always look to see is the patient eligible for a clinical trial and we offer it to them if they're eligible and we explain what a clinical trial is and what is the advantage of participating in the clinical trial and what are the risks of participating in the clinical trial. And if the patient is interested, then we would love to enroll patients in clinical trials because it's the only way we're going to get additional therapies. All of the tests that we discussed, the genetics and the molecular testing, help the practitioner talk about options. We look at the biology of the disease and complement that with the patient's goals and wishes for therapy. What risks they're willing to take, what potential benefits are meaningful to them, and come up with a treatment plan that's as personalized as possible. What do some of these treatment plans look like? So based on the heterogeneity of AML, in terms of thinking of the treatment path for AML, I can't be too specific in that answer, but there are three main buckets you might think about. One would be a standard aggressive combination chemotherapy regimen, which typically would have the patient in the hospital for a month recovering, going through some of the side effects we talked about with low blood counts, risk for infection, poor nutrition with mouse sores, nausea, vomiting, diarrhea, potentially damage to the heart and liver, that type of thing. An alternative approach would be to be very gentle and focus on just quality of life as an outpatient at home with a family, but not having active intervention to treat the leukemia. That would be more of a comfort care and in some cases hospice approach for patients. Many times we have what I consider more middle of the road or slow boat approaches where we can have effective therapy with less toxicity that patients may be willing to attempt. If they have a chance to get remission, provide longer quality time, and even if it's not curative, those goals are still important for many patients. So we talk about a middle of the road approach where some of the newer therapies can be combined using the FDA on-label guidance for using these agents that can target the therapy in a more personalized, targeted fashion to the leukemia. And hopefully the plan would be that we do that with less toxicity to the patient so they are at home longer with a better quality of life for a longer period. That's the goal in most of these current circumstances.