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Treatment Advances in Secondary AML and Older Populations: The Age of Abundance

By: Meg Barbor, MPH
Posted: Tuesday, January 19, 2021

After several stagnant decades following the “Age of Induction” in acute myeloid leukemia (AML), the tides have again shifted, ushering in a plethora of new treatment options and a new “Age of Abundance,” according to Daniel A. Pollyea, MD, MS, of the University of Colorado Cancer Center. At the 2020 NCCN Annual Congress on Hematologic Malignancies,

Dr. Pollyea discussed advancements in the field, particularly about how this progress has allowed for more tailored treatment options for patients with secondary AML and older patients with AML. Highlights from his presentation were published in JNCCN–Journal of the National Comprehensive Cancer Network.

In treating patients with secondary AML, liposomal daunorubicin and cytarabine (CPX-351), a liposomal formulation of 7+3 (cytarabine plus anthracycline), has led to statistically significant survival improvements, particularly in those who went on to transplant. “So, consider CPX-351 for newly diagnosed, induction-eligible secondary AML patients, particularly if they would be suitable candidates for a transplant,” he said. Other treatment options include glasdegib plus low-dose cytarabine or ivosidenib (applicable in patients with IDH1 mutations) in patients who are not eligible for induction chemotherapy. Additionally, venetoclax plus azacitidine has led to similar responses among patients with secondary AML and those with de novo AML.

In older patients, the standard treatment recommendation is intensive induction chemotherapy for patients with “good-risk” features. However, Dr. Pollyea noted, assessing “fitness” in this population can be challenging. “Good-risk” patients are typically rare, often due to worse disease biology that is less responsive to induction chemotherapy.

In older patients unfit for intensive chemotherapy, responses favor venetoclax/azacitidine. “So, perhaps in the context of a venetoclax-based regimen, poor-risk cytogenetics don’t have the bad predictive value they have for intensive chemotherapy,” he said. “The reality is that some of these therapies designed for ‘unfit’ patients may be better for the ‘fit’ patients.”

Disclosure: For Dr. Pollyea’s disclosures, visit education.nccn.org.


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