Evolving paradigms in AML treatment

Friday, August 25, 2017

Gail Roboz, M.D., a professor of medicine and director of the Clinical and Translational Leukemia Program at Weill Cornell Medicine/NewYork-Presbyterian Hospital, spoke to OncLive about evolving paradigms in treatment of patients with acute myeloid leukemia (AML).

AML is moving away from conventional immunophenotype and cytogenetic morphological baseline diagnosis due to new technologies taking the field in a different direction, Roboz explains. Next-generation sequencing is now the standard of care for patients with AML to determine if there may or may not be clinical trials or standard-of-care opportunities for FLT3-mutated patients.

Additionally, there has been a guideline change for outcomes in AML. Complete response will also include a subclassification of minimal residual disease (MRD)–negative or -positive. While this is controversial, it is important to assess for MRD for both flow cytometry and by molecular assessment for molecularly defined AML. In combination regimens, new types of evaluations with both sequencing strategies and with more detailed flow cytometry-based assessments and remission are very important.

Dr. Roboz also appeared in another video to discuss advancements emerging on the horizon in acute myeloid leukemia (AML).

While agents have emerged and have been FDA approved in other hematologic malignancies, there are similar advancements finally occurred in the AML landscape, Roboz explains. There are several promising combination therapies that are building on standard chemotherapy backbones. For older patients, hypomethylating agents and low-dose cytarabine are regimens that are less likely to yield many complete remissions (CRs) or long-term outcomes.

However, they are being combined successfully with novel agents. Some of these potential combinations in early trials include CR rates of more than 60% at this point, which is much better than the 15% to 25% CR rate that we are used to.