The treatment landscape and challenges in rare diseases: BPDCN, CMML, MPN-AP/BP, and VEXAS
Nov 6, 2024
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Marina Konopleva is the Director of Leukemia at Montefiore Cancer Center, while Emma Groarke is an Associate Research Physician at the NIH. They delve into the landscape of rare myeloid diseases like BPDCN, CMML, and VEXAS, discussing innovative therapies including Tagrexofaspa and IDH inhibitors. The conversation highlights the complexities in treatment due to patient variability and the significance of risk stratification in decision-making. They also emphasize the importance of collaborative research to enhance outcomes in these challenging conditions.
The podcast discusses the promising advancements in targeted therapies for BPDCN, yielding a 70% response rate but limited overall survival.
Various treatment challenges in CMML are highlighted, emphasizing the need for targeted therapies due to its genetic and clinical diversity.
Deep dives
Innovations in Treating BPDCN
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive disease with a low incidence rate. Recent advancements have led to the approval of targeted therapies like Tagraxofus and PIVAC, which target CD123, a receptor overexpressed in BPDCN cells. A significant study demonstrated a high response rate of around 70% in newly diagnosed patients, although overall survival was still limited to about 15 months. The goal remains to achieve remission and then transition patients to allogeneic stem cell transplantation, enhancing their chances of long-term survival.
Challenges in Chronic Myelomonocytic Leukemia (CMML)
Chronic myelomonocytic leukemia (CMML) presents significant challenges due to its genetic and clinical diversity. Patients often exhibit varying symptoms and responses to treatment, highlighting the need for targeted therapeutic approaches. Novel therapies targeting specific mutations and pathways, such as LSD1 inhibitors, are currently being explored to address unmet needs in both low-risk and high-risk subsets of CMML. There is a growing optimism in the scientific community regarding the development of effective treatments, informed by a deeper understanding of CMML's biology.
Addressing Vexas Syndrome and Its Treatment
Vexas syndrome, caused by mutations in the UBA1 gene, leads to inflammatory symptoms and hematologic complications. Steroids are the primary treatment, but many patients remain dependent on them, with emerging therapies needed for effective management. In addition to drug therapies, allogeneic stem cell transplantation shows promise in eradicating UBA1 mutations, although it carries risks of complications like graft-versus-host disease. Research is ongoing to develop better risk stratification tools and targeted therapies to improve outcomes for patients with this condition.
This podcast features a discussion from the 6th International Workshop on Acute Leukemias (iwAL) 2024, which took place in Phoenix, AZ. You will hear from Anand Patel, MD, University of Chicago Medical Center, Chicago, IL, Marina Konopleva, MD, PhD, Albert Einstein College of Medicine, New York City, NY, Guillermo Montalban-Bravo, MD, The University of Texas MD Anderson Cancer Center, Houston, TX, and Emma Groarke, MD, National Institutes of Health, Bethesda, MD, who discuss several rare myeloid diseases, including accelerated- and blast-phase myeloproliferative neoplasms (MPN-AP/BP), blastic plasmacytoid dendritic cell neoplasm (BPDCN), chronic myelomonocytic leukemia (CMML), and VEXAS syndrome. The experts provide valuable insight into the treatment of these diseases and the unique challenges associated with each one.