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What’s the Course of Care for AML Patients Who Relapse?

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Published on August 13, 2019

How long will acute myeloid leukemia (AML) remission last? What options do relapsed AML patients have? During this Ask the Expert segment, Dr. Daniel Pollyea, from the University of Colorado School of Medicine, discusses AML treatment goals, remission duration and next steps after a relapse. Watch now to learn his expert knowledge about working toward AML remission. 

This program is sponsored by AbbVie, Inc and Genentech, Inc. It is produced by Patient Power in partnership with The Leukemia & Lymphoma Society (LLS) and NeedyMeds. These organizations have no editorial control, and Patient Power is solely responsible for program content.

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Transcript | What’s the Course of Care for AML Patients Who Relapse?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:          

So, Dr. Pollyea, whether it's younger patients, or a fitter older patient, everybody says, okay, if you can get me an effective treatment now, and get me into remission, how long is it going to last, or if I come out of remission, what do we do then? So, we're really talking about the uncertainty of this journey. 

Dr. Pollyea:                 

Yeah. That's a big struggle for patients, families, and for us too. So, I think there are two questions there. You know, as far as how long could one expect a remission to last, the true answer is nobody knows. I mean, so anyone who tells a patient that your remission will last x months, or weeks, or whatever, that's an impossible thing that they are telling you. So, we have in our experience, statistics, large numbers of patients, we can come up with expectations, but we cannot apply any of that to an individual patient. 

So, you have to be really careful…I know that’s what everybody wants to know. That's the question everyone would want to know, but the truth is, nobody knows the answer to it, and you could push a person for an answer, and you might even get an answer, but that answer is not reliable. That would be akin to predicting the future, and of course, nobody can do that. What I would say is that the remission duration are very dependent on what treatment you're getting, and very dependent on the biology of a patient's disease. 

So, those are the two things that really go in to trying to suss out what an expectation for a remission duration might be. But I will say that patients who I might predict would have a very brief duration of remission have been in remission in my experience for years. And the opposite is also true. I've had patients who relapsed very unexpectedly. The truth is is that this disease is still very poorly understood. As good as we are getting at understanding this disease, the truth is is that, it's difficult to make predictions in AML. 

As far as what to do after a relapse, that is a huge challenge. Once this disease relapses from any therapy, be it chemotherapy, one of these novel new therapies, or transplants, it can be very difficult to get back under control. And historically, outcomes have been very poor in this situation. We do have no, like I alluded to before, there are some targeted therapies, if your disease has a particular mutation that we can exploit with one of these pills, that would be a logical thing to do.  

There are other chemotherapy regimens, probably drugs that the disease probably hasn’t yet seen, if a person is still a candidate for an intensive induction chemotherapy type approach. We have a lot of tricks up our sleeve. We have a lot of things that we can do, but in general, that's a challenging situation.  

Andrew Schorr:          

Okay. But you referred to the pipeline earlier, which means there could be something in development, like in a clinical trial where you are, the University of Colorado, that could be part of the discussion, whether tomorrow's medicine could work for you today in a trial to try to get you a second remission. 

Dr. Pollyea:                 

Absolutely. Clinical trials are – we have to continue to develop, design, and put patients on clinical trials if we are going to learn anything about this disease, and if we are to have any hope for the future. All of these exciting developments that have come to fruition just very recently are the result of clinical trials in patients who volunteered to participate in unknown situations, and doctors who are willing to go there with them. So, that's a really crucial part of all this. 

And in fact, just to give you some semblance of how important this is, if you go to the National Comprehensive Cancer Network website, the NCCN, and you find the—they have treatment recommendations for every type of cancer, almost every situation for every type of cancer, and if you look up what's the number one recommendation for a relapsed AML patient, in some cases, even a newly diagnosed AML patient, but certainly for relapse, number one recommendation is to participate in a clinical trial. 

So, that's an acknowledgement that this is not an area that we're currently very good at, but it's also indicative that we have hope, like you said, that some of these new therapies are going to be the future. And it's a gamble, it's an experiment that you're participating in, but we always hope that, like you said, that the patient is going to get a treatment right now, that if we could peer ahead five years into the future, that's how we're going to be treating everybody. 

And that's what's happened in our experience running all these clinical trials the last couple years, we had the opportunity to be providing therapies of the future to people in the present. And that's why we do what we do. That's an exciting thing to do. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.