Meet The Professor: Optimizing the Management of Acute Myeloid Leukemia and Myelodysplastic Syndromes — Part 1 of a 3-Part Series
Oct 20, 2023
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Dr Naval Daver from The University of Texas MD Anderson Cancer Center discusses optimizing the management of acute myeloid leukemia and myelodysplastic syndromes. Topics include the productivity of researchers in leukemia, the potential of checkpoint inhibitors, challenges of managing TP53 mutated disease, various drug therapies for AML and MDS, management of qtc prolongation, combination therapy, and the continuation of Van Aza treatment.
Targeted therapies like flip 3 inhibitors or ideh inhibitors show promise for specific molecular mutations in AML and MDS patients.
In managing AML and MDS, performing a bone marrow biopsy at the end of a treatment cycle is crucial for assessing response and adjusting treatment plans.
Deep dives
Treatment options for MDS and AML
The management of AML and MDS often involves a multidimensional approach. The use of targeted therapies, such as flip 3 inhibitors or ideh inhibitors, can be effective, especially in patients with specific molecular mutations. Combination therapies, such as HMAVN or HMAVN with a targeted therapy, show promise in elderly patients. The decision to pursue intensive treatment versus non-intensive treatment depends on factors such as age, comorbidities, and the potential for stem cell transplantation. In certain cases, oral hypomethylating agents, like oral decidobene, could be used for convenience. Maintenance therapy, especially after achieving remission, is being explored as a way to improve outcomes. Lastly, the use of antibody drug conjugates, like C-D123 ADC, shows potential for specific subsets of AML. However, further research is needed to fully understand their efficacy.
The importance of antifungals and bone marrow biopsy
In the management of AML and MDS, the use of antifungal medications is regionally driven and depends on the fungal incidence in the area. Performing a bone marrow biopsy at the end of a treatment cycle is essential for assessing response and adjusting treatment plans accordingly. The decision to prescribe antifungals and perform a bone marrow biopsy should be based on individual patient characteristics and physician discretion.
Treating AML and myeloma overlap
When AML and myeloma overlap, treatment decisions should be based on the specific characteristics of the patient and their disease. For patients with both myeloma and MDS, treating the myeloma with agents like lenalidomide may help improve anemia. In older patients, starting with a lower dose of lenalidomide and adjusting as necessary may be recommended. Close monitoring of the patient's response and adjusting treatment plans accordingly is crucial in these cases.
Managing cytopenia in AML treatment
Cytopenia is a common concern during AML treatment, particularly with regimens like CPX351. Dose reduction or schedule adjustments may be necessary to allow for count recovery. Close monitoring of blood counts, immediate response to cytopenia, and adjusting treatment plans accordingly is essential to manage cytopenia effectively. For elderly patients, lower-dose regimens may be considered to balance efficacy and tolerability.
Dr Naval Daver from The University of Texas MD Anderson Cancer Center in Houston, Texas, discusses current and emerging optimal management approaches for patients with acute myeloid leukemia and myelodysplastic syndromes.
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