© 2024 HSP News Service, L.L.C.
In this video, Drs. Richard Stone, Courtney DiNardo, and Eunice Wang discuss therapy options for minimal residual disease (MRD)-positive acute myeloid leukemia (AML). The case is a 44-year-old man with no past medical history who presents with fevers and fatigue. He is diagnosed with AML and achieves morphologic remission after treatment with 7+3 (cytarabine/daunorubicin) plus gemtuzumab; however MRD flow cytometry reveals 0.1% blasts, which persists after consolidation with high-dose cytarabine. The faculty discuss how they would approach the next steps for this patient and the importance of reducing the disease burden prior to the initiation of allogeneic stem cell transplant.
In this video, Drs. Richard Stone, Courtney DiNardo, and Eunice Wang treatment options for primary refractory FLT3-ITD–positive acute myeloid leukemia (AML). The case is a 60-year-old man with a history of hypertension and hyperlipidemia who presents with fatigue. He is diagnosed with FLT3-ITD–positive AML and is enrolled in a clinical trial where he receives 7+3 (cytarabine/daunorubicin) and midostaurin; after achieving complete remission, his disease eventually recurs. The faculty discuss potential treatment options for this patient, such as FLAG-IDA-VEN and gilteritinib both alone and in combination.
In this video, Drs. Richard Stone, Courtney DiNardo, and Eunice Wang discuss the management of newly diagnosed older patients with acute myeloid leukemia (AML). The case is a 75-year-old woman with no past medical history who presents with fever and bone pain. She is diagnosed with AML, and next-generation sequencing reveals a mutation in IDH1, among others. The faculty discuss the potential choices for induction therapy in older patients such as this, debating the merits of intensive chemotherapy vs lower-intensity options such as azacitidine/venetoclax and azacitidine/ivosidenib.
This is Part 1 of Updates in Acute Myeloid Leukemia, a four-part video roundtable series. Scroll down to watch the other videos from this Roundtable. In this video, Drs. Richard Stone, Courtney DiNardo, and Eunice Wang discuss the management of newly diagnosed younger patients with acute myeloid leukemia (AML). The case is a 23-year-old woman with no past medical history who presents with very heavy menstrual periods and fatigue, and is diagnosed with AML with key mutations found in DNMT3A, NPM1, and IDH2. The faculty discuss the evolution of induction therapy options for younger patients with AML, as oncologists move from standard 7+3 (cytarabine/daunorubicin) chemotherapy to more personalized approaches.
“The value of experience is not in seeing much, but in seeing wisely.” —Sir William Osler To complement The ASCO Post’s continued comprehensive coverage of the 2021 American Society of Hematology (ASH) Annual Meeting & Exposition, here are several abstracts selected from the meeting...
As reported in the Journal of Clinical Oncology by Teachey et al, the phase III Children’s Oncology Group AALL1231 trial has shown that the addition of bortezomib to a modified augmented Berlin-Frankfurt-Münster (BFM) backbone improved survival outcomes in patients with newly diagnosed T-cell...
Black and Hispanic people with acute myeloid leukemia (AML) in the greater Chicago area were more likely to die from the disease than their non-Hispanic White counterparts, with a 59% and 25% greater risk, respectively, according to a new study led by University of Illinois Chicago researchers. In...
In a study reported in The New England Journal of Medicine, Wang et al identified mutations that conferred resistance to noncovalent Bruton’s tyrosine kinase (BTK) inhibitors in patients with chronic lymphocytic leukemia (CLL) and found that some also conferred resistance to covalent BTK...
A new mutation was identified in 9% of relapsed cases of pediatric acute myeloid leukemia (AML) that may define a new subtype of the disease, according to a study published by Umeda et al in Blood Cancer Discovery. The mutation is a tandem duplication (a series of adjacent repeats of a DNA...
In the phase II SWOG 1318 trial reported in the Journal of Clinical Oncology, Advani et al found that blinatumomab induction and consolidation followed by maintenance with POMP (prednisone, vincristine, mercaptopurine, and methotrexate) produced good outcomes in patients aged ≥ 65 years with newly...
Administering time-limitedcombination regimens of venetoclax plus obinutuzumab or venetoclax plus obinutuzumab and ibrutinib was superior to chemoimmunotherapy in achieving undetectable measurable residual disease (MRD) in the peripheral blood at month 15 in fit patients with chronic lymphocytic...
In patients with newly diagnosed acute myeloid leukemia (AML) with an IDH1 mutation who were ineligible for intensive chemotherapy, the addition of the IDH1 inhibitor ivosidenib to azacitidine significantly improved survival vs azacitidine alone, according to data presented at the 2021 American...
Two different trials presented at the 2021 American Society of Hematology (ASH) Annual Meeting & Exposition found that fixed-duration treatment with ibrutinib and venetoclax achieved deep and sustained undetectable measurable residual disease (MRD) status when used as first-line therapy for...
Administering time-limited regimens that were combinations of venetoclax plus obinutuzumab or venetoclax plus obinutuzumab and ibrutinib was superior to chemoimmunotherapy in achieving undetectable measurable residual disease in the peripheral blood at month 15 in fit patients with chronic...
A woman with human immunodeficiency virus (HIV) who received a cord blood stem cell transplant to treat acute myeloid leukemia has had no detectable levels of HIV for 14 months, despite cessation of antiretroviral therapy, according to research presented at the Conference on Retroviruses and...
The start of January 2014 was filled with excitement. I was undergoing fertility treatments to have a second child and was living my professional dream. I was a network news anchor and medical news reporter for a national broadcast network. Although I was exhausted from my grueling early morning...
Joshua Brody, MD, Director of the CLL/Lymphoma Immunotherapy Program, Icahn School of Medicine at Mount Sinai, New York, who was not involved in these trials, commented: “CLL is an extremely prevalent disease affecting nearly 200,000 patients in the United States. Most patient do not require...
Two different trials presented at the 2021 American Society of Hematology (ASH) Annual Meeting & Exposition found that fixed-duration treatment with ibrutinib and venetoclax achieved deep and sustained undetectable measurable residual disease (MRD) status when used as first-line therapy for...
In an interview with The ASCO Post, Hanno R. Hock, MD, PhD, Assistant Professor of Medicine at Harvard Medical School and Massachusetts General Hospital, highlighted the study’s “very nice response rate” and “encouraging data” while also noting that a pediatric-based treatment regimen in fit adults ...
A pediatric-based protocol has delivered promising preliminary results in adults with acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL), according to data presented at the 2021 American Society of Hematology (ASH) Annual Meeting & Exposition.1 Findings from the large,...
In a study reported in the Journal of Clinical Oncology, Elsayed et al developed a risk score based on single nucleotide polymorphisms (SNPs) associated with cytarabine pharmacodynamics or clinical outcomes that identified pediatric patients with acute myeloid leukemia (AML) who could benefit from...
Scientists at St. Jude Children’s Research Hospital are studying the impact of genetic ancestry on childhood acute lymphoblastic leukemia (ALL). The scientists assembled an international cohort to determine how genetic ancestry affects leukemia biology and outcomes for modern therapy; they found...
Matthew S. Davids, MD, of Dana-Farber Cancer Institute, discusses phase II results from a multicenter study that showed the efficacy of ibrutinib plus fludarabine, cyclophosphamide, and rituximab in younger, fit patients with chronic lymphocytic leukemia who desire the possibility of a functional cure with time-limited therapy (Abstract 640).
On December 2, 2021, rituximab was approved for use in combination with chemotherapy for pediatric patients (≥ 6 months to 18 years) with previously untreated, advanced-stage, CD20-positive diffuse large B-cell lymphoma, Burkitt lymphoma, Burkitt-like lymphoma, or mature B-cell acute leukemia.1...
In a phase II trial (Children’s Oncology Group AALL1621) reported in the Journal of Clinical Oncology, O’Brien et al found that inotuzumab ozogamicin produced a high response rate in children and adolescents with relapsed or refractory B-cell acute lymphoblastic leukemia (ALL). Study Details In the ...
A retrospective, registry-based multicenter study by Bazarbachi et al published in Clinical Cancer Research evaluated clinical outcomes in patients with relapsed Philadelphia chromosome–positive (Ph+) acute lymphoblastic leukemia (ALL) after allogeneic hematopoietic cell transplantation over a...
In patients with newly diagnosed acute myeloid leukemia (AML) with an IDH1 mutation who were ineligible for intensive chemotherapy, the addition of the IDH1 inhibitor ivosidenib to azacitidine significantly improved survival vs azacitidine alone, according to data presented at the 2021 American...
Although allogeneic hematopoietic cell transplantation can result in a cure for patients with advanced hematologic malignancies, studies show chronic graft-vs-host disease occurs in 30% to 60% of patients receiving unmanipulated grafts, often requires prolonged immunosuppression, and may cause...
Musa Yilmaz, MD, of The University of Texas MD Anderson Cancer Center, discusses study results suggesting that quizartinib with decitabine and venetoclax is active in patients with FLT3-ITD–mutated acute myeloid leukemia and that RAS/MAPK mutations continue to drive primary and secondary resistance (Abstract 370).
In an analysis from the Pediatric Real-World Chimeric Antigen Receptor Consortium reported in the Journal of Clinical Oncology, Schultz et al found that pretreatment high disease burden was associated with poorer outcomes in pediatric and young adult patients who received commercial...
In a trial-level analysis of randomized studies submitted to the U.S. Food and Drug Administration (FDA) reported in the Journal of Clinical Oncology, Norsworthy et al found that complete remission rate was moderately correlated, and event-free survival was strongly correlated, with overall...
Sangeetha Venugopal, MD, of The University of Texas MD Anderson Cancer Center, discusses a retrospective analysis of 562 patients with treated secondary acute myeloid leukemia and prior exposure to hypomethylating agents (HMAs). The results showed that an HMA plus venetoclax yielded significantly higher overall response rates and improved overall survival compared with intensive chemotherapy or low-intensity chemotherapy, particularly in patients 60 years or older who had a karyotype without adverse risk (Abstract 794).
Andrew Matthews, MD, of the Abramson Cancer Center, University of Pennsylvania, discusses findings from a retrospective study at an academic institution, which showed there was no statistically significant difference in overall survival between induction with CPX-351 and venetoclax/azacitidine for adults with acute myeloid leukemia. Prospective studies to confirm similar effectiveness with careful attention to side effects, quality of life, and impact on transplant outcomes may help clinicians decide between these therapies (Abstract 795).
�In an analysis from the phase III VIALE-A study reported in the Journal of Clinical Oncology, Keith W. Pratz, MD, and colleagues found that among treatment-naive patients with acute myeloid leukemia (AML) who experienced complete remission after receiving treatment with venetoclax/azacitidine,...
Krish Patel, MD, Director of the Lymphoma Program at the Swedish Cancer Institute in Seattle and Interim Director of the Hematological Malignancies and Cellular Therapy Program, commented on the implications of Dr. Soumerai’s presentation. “We know that, in general, reaching [undetectable...
Achieving undetectable measurable residual disease (MRD) is an important milestone in the treatment of patients with chronic lymphocytic leukemia (CLL) as well as those with other hematologic malignancies undergoing treatment. Now a small phase II study, presented at the 2021 American Society of...
Alba Rodriguez-Meira, DPhil, of the University of Oxford, discusses a comprehensive analysis of the genetic, cellular, and molecular landscape of TP53-mediated transformation, providing insights into the evolution of chronic hematologic malignancies toward an aggressive acute leukemia. Because TP53 is the most commonly mutated gene in human cancer, these findings may well be of broad relevance (Abstract 3).
In an analysis from the Children’s Oncology Group AAML1031 trial reported in the Journal of Clinical Oncology, Lamble et al found that increased CD123 expression was associated with high-risk genetic alterations and poorer treatment outcomes in pediatric patients with newly diagnosed acute myeloid...
Eunice S. Wang, MD, of Roswell Park Comprehensive Cancer Center, discusses phase III results showing that gilteritinib and azacitidine led to significantly higher composite complete response rates in patients with newly diagnosed FLT3-mutant acute myeloid leukemia who are ineligible for intensive induction chemotherapy. Overall survival was similar to that of azacitidine alone (Abstract 700).
Carsten Utoft Niemann, MD, PhD, of Copenhagen University Hospital, discusses a primary analysis of the phase II Vision HO141 trial, which showed the feasibility of stopping and restarting ibrutinib and venetoclax in patients with relapsed or refractory chronic lymphocytic leukemia who have undetectable measurable residual disease. A favorable benefit-risk profile was demonstrated, with no new safety signals (Abstract 69).
Masayuki Umeda, MD, of St. Jude Children's Research Hospital, discusses his research which showed that UBTF-TD (upstream binding transcription factor-tandem duplications) define a unique subtype of acute myeloid leukemia that previously lacked a clear oncogenic driver. UBTF-TD is associated with FLT3-ITD and WT1 mutations, adolescent age, and poor outcomes. These alterations are critical for future risk-stratification for this patient cohort.
A study presented by Matthew S. Davids, MD, of Dana-Farber Cancer Institute, and colleagues at the 2021 American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 640) suggests that a 2.5-year regimen involving ibrutinib and chemoimmunotherapy may provide deep and lasting...
Talha Badar, MD, of the Mayo Clinic, discusses the near-universal poor outcomes for patients with TP53-mutated acute myeloid leukemia and the findings that show allogeneic stem cell transplantation appears to improve the long-term survival in a subset of these patients. Effective therapies may successfully bridge patients to transplant and prolong survival for those who are transplant-ineligible (Abstract 797).
In separate analyses of 257 patients with acute leukemia or myelodysplastic syndrome (MDS) who developed COVID-19 and are part of the American Society of Hematology (ASH) RC COVID-19 Registry for Hematology, both neutropenia and having active MDS or leukemia (vs being in remission) were found to...
Oncologists and health-care professionals who treat patients with high-risk acute myeloid leukemia (AML) are missing important opportunities to have end-of-life discussions at earlier stages in the disease course, when patients are best able to discuss their options and preferences. These findings...
In the phase III AGILE trial, the combination of ivosidenib and azacitidine was found to be superior in treating newly diagnosed patients with IDH1-mutated acute myeloid leukemia (AML) compared to azacitidine alone in terms of event-free survival, the study’s primary endpoint. The combination also...
In one of the largest studies to date of the antibody response to vaccination against COVID-19 in people who had been treated for acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS), patients responded well to two doses of the Moderna mRNA vaccine and saw a pronounced increase in levels ...
Paolo Ghia, MD, PhD, of the Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, discusses disease-free survival results from the measurable residual disease cohort of the phase II CAPTIVATE trial. This multicenter trial focuses on first-line ibrutinib plus venetoclax in patients with chronic lymphocytic leukemia (Abstract 68).
A study of U.S. adolescent and young adult patients with acute lymphoblastic leukemia (ALL) found that Hispanic patients were significantly underrepresented in a large clinical trial compared with the general patient population. The study, presented by Muffly et al at the 2021 American Society of...
A study of nearly 25,000 patients with acute lymphoblastic leukemia (ALL) aged up to 30 years old revealed significant gaps in survival rates between White, Hispanic, and Black patients, as well as worse outcomes among those of lower socioeconomic status. Biologic or genetic factors accounted for...