Response kinetics and clinical benefits of non-intensive AML therapies in the absence of morphologic response

Publication date: Available online 26 November 2019Source: Clinical Lymphoma Myeloma and LeukemiaAuthor(s): Eytan M. Stein, Courtney D. DiNardo, Daniel A. Pollyea, Andre C. SchuhAbstractThe ultimate goal of treatment for acute myeloid leukemia (AML) is to improve survival, and the best means of doing so is through the induction of morphologic remission, historically most reliably achieved with intensive chemotherapy regimens. Older patients with AML are less likely to be candidates for, or to benefit from, intensive chemotherapy. Patients deemed ineligible for intensive therapy may nevertheless benefit from lower intensity therapies and from newly available, targeted AML treatments. Recently approved, lower-intensity treatments for AML include enasidenib, ivosidenib, glasdegib, venetoclax, midostaurin, and gilteritinib, and additional promising agents are in later stages of clinical development. Non-cytotoxic agents may result in slower kinetics of therapeutic activity compared with intensive regimens, and although they are generally better tolerated than intensive chemotherapy, bone marrow responses are less frequent and may take longer to achieve. Notably, newer therapies might have been considered ineffective had they been judged solely by 2003 IWG response criteria for AML, which were based on experience with intensive regimens in predominantly younger patients. Lower-intensity therapies may require several treatment cycles to induce responses, and failure to achieve rapi...
Source: Clinical Lymphoma Myeloma and Leukemia - Category: Cancer & Oncology Source Type: research

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ConclusionOur study did not find a statistically significant difference in the overall response rates or survival outcome measures for patients with AML and indeterminate day 14 bone marrow in the 2 treatment groups. Our findings question the utility of immediate reinduction chemotherapy and raise concern regarding overtreatment in this patient population. Larger studies investigating similar outcomes are warranted to validate our clinical findings.
Source: Clinical Lymphoma Myeloma and Leukemia - Category: Cancer & Oncology Source Type: research
ConclusionsThe high ORR and reasonable duration of response could allow for potentially curative allogeneic hematopoietic cell transplantation for these patients with high-risk AML. Our initial data suggest that lenalidomide plus HMA is a promising approach for patients with AML with inv(3).
Source: Clinical Lymphoma Myeloma and Leukemia - Category: Cancer & Oncology Source Type: research
ConclusionsThis is the first multicenter report analyzing AML-survival in Mexico. Challenges in this setting include a high induction-related mortality and low AlloHSCT rate, which should be addressed in order to improve outcomes.
Source: Clinical Lymphoma Myeloma and Leukemia - Category: Cancer & Oncology Source Type: research
Publication date: Available online 24 December 2019Source: Clinical Lymphoma Myeloma and LeukemiaAuthor(s): Yedla Rajani Priya, Stalin Chowdary Bala, Venkateswara Rao Pydi, Kuruva Siva Prasad, Rachana Chennamaneni, Meher Lakshmi Konatam, Tara Roshni Paul, Sadashivudu GundetiAbstractBackgroundAcute promyelocytic leukemia, a distinct variant of acute myeloid leukemia (AML) accounts for 10% of AML cases. Over the past decade, APL had emerged from a highly fatal disease to a highly curable one. The published data on outcomes of APL from India is scant. The present study was designed to analyse the clinicopathological features ...
Source: Clinical Lymphoma Myeloma and Leukemia - Category: Cancer & Oncology Source Type: research
Publication date: Available online 24 December 2019Source: Clinical Lymphoma Myeloma and LeukemiaAuthor(s): Prajwal Dhakal, Bimatshu Pyakuryal, Prasun Pudasainee, Venkat Rajasurya, Krishna Gundabolu, Vijaya Raj BhattAbstractProspective evidence for management of therapy-related acute myeloid leukemia (t-AML) is limited, with evidence extrapolated from major AML trials. Optimal treatment is challenging and needs consideration of patient-specific, disease-specific, and therapy-specific factors. Clinical trials are recommended, especially for unfit patients or those with unfavorable cytogenetics or mutations. CPX-351 as an up...
Source: Clinical Lymphoma Myeloma and Leukemia - Category: Cancer & Oncology Source Type: research
Acute promyelocytic leukemia, a distinct variant of acute myeloid leukemia (AML) accounts for 10% of AML cases. The present study was designed to analyse the clinicopathological features and outcomes in adult APL. The present report is a retrospective observational study of APL patients diagnosed between 2006 and 2018. A total of 111 were analyzed. The median age at presentation was 33 years (range, 19-60). High risk, intermediate risk and low risk were seen in 43.3%, 41.4% and 15.3% patients respectively. At a median follow up of 34 months, the event free survival and overall survival was 69.3% and 74.7% respectively. APL...
Source: Clinical Lymphoma, Myeloma and Leukemia - Category: Hematology Authors: Tags: Original Study Source Type: research
Prospective evidence for management of therapy-related acute myeloid leukemia (t-AML) is limited, with evidence extrapolated from major AML trials. Optimal treatment is challenging and needs consideration of patient-specific, disease-specific, and therapy-specific factors. Clinical trials are recommended, especially for unfit patients or those with unfavorable cytogenetics or mutations. CPX-351 as an upfront intensive chemotherapy is preferred for fit patients; venetoclax with decitabine or azacitidine is an option for patients unfit for intensive chemotherapy.
Source: Clinical Lymphoma, Myeloma and Leukemia - Category: Hematology Authors: Tags: Review Article Source Type: research
Publication date: Available online 26 November 2019Source: Clinical Lymphoma Myeloma and LeukemiaAuthor(s): Eytan M. Stein, Courtney D. DiNardo, Daniel A. Pollyea, Andre C. SchuhAbstractThe ultimate goal of treatment for acute myeloid leukemia (AML) is to improve survival, and the best means of doing so is through the induction of morphologic remission, which is historically most reliably achieved with intensive chemotherapy regimens. Older patients with AML are less likely to be candidates for or to benefit from intensive chemotherapy. Patients deemed ineligible for intensive therapy may nevertheless benefit from lower-in...
Source: Clinical Lymphoma Myeloma and Leukemia - Category: Cancer & Oncology Source Type: research
ConclusionVenetoclax therapy in a real-world cohort offered modest benefits in heavily pretreated patients. Adverse events were observed at a greater incidence than in the clinical trials. A wide heterogeneity of venetoclax dose escalation, multiagent combinations, and timing of initiation were identified and require investigation in subsequent clinical trials.
Source: Clinical Lymphoma Myeloma and Leukemia - Category: Cancer & Oncology Source Type: research
Conclusion: TA, FLAG and CLARA regimens are efficient and associated with acceptable toxicity in AML patients ineligible for "3+7" regimen due to cardiac comorbidities. However, long term outcome remains disappointing highlighting the need for the development of less toxic regimens.
Source: Clinical Lymphoma Myeloma and Leukemia - Category: Cancer & Oncology Source Type: research
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