Skip to Navigation Skip to Search Skip to Content
Search All Centers

AML Treatment Tailored to Different Patients and Needs

Read Transcript
View next

Published on January 26, 2016

Dr. Alan Burnett from Cardiff University, Cardiff, UK discusses different ways in which acute myeloid leukaemia (AML) patients can be treated. Dr. Burnett describes three types of patients: young, fit patients; older, fit patients; and older patients with other medical conditions. He covers options for each group, including chemotherapy and bone marrow transplant, and the risks and complications associated with each.
Recorded at the American Society of Hematology (ASH) Annual Meeting 2015, in Orlando, FL.

This programme has been supported by Pfizer, through an unrestricted educational grant to the Patient Empowerment Foundation

Featuring

Transcript | AML Treatment Tailored to Different Patients and Needs

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.

If a patient turns up with acute myeloid leukaemia, which is not difficult to diagnose and they usually get into the hospital pretty quickly, I tend to look at them in three categories.  There’s the younger patient who are the minority, where you know that the thing to do is give them an intensive chemotherapy schedule, possibly including transplantation.  Then there’s the older patient, arbitrarily defined by 65, 60 to 65 or over, but arbitrary, and you know that some of them will benefit from intensive chemotherapy, but not necessarily as much as the younger patients because you do have to compromise on the intensity that you can safely give.  And the third group is the probably nearly 40% of all the patients who are over the age of 70.  And here you run into issues that you can’t throw intensive chemotherapy at these patients easily, because they have other medical conditions that make them quite susceptible to complications.

So there are kind of different strategies for these three groups of patients, so age and general fitness is something that any doctor will look at when the patient first meets them.  Younger patients, give them treatment, a very high chance that the disease will go away, at least as detectible under the microscope.  So there are various chemotherapy schedules that will produce the same percentage chance of getting into remission, and in the UK, for example, this is over 80% now. 

The problem is keeping patients in remission.  The best theoretical way to do it is to offer a transplant, but the transplant has got associated complications and risks of its own.  And so we can predict by the time we have given the first treatment, the patient is very likely on their way or in remission, we then have the cytogenetics and some molecular information taken at the time of diagnosis, and this guides us to what to do next.  And we know that some of these molecular abnormalities predict a favourable response to conventional chemotherapy with 70%, 80% chance of cure.  Some predict a fairly high chance of relapse and relapse soon, and these are the patients that you’d want to get a transplant done.  And then there’s a large group in the intermediate group, and here we’re looking to the prognostic information, all this new molecular diagnostics can give to try and separate them into who should perhaps be sent to transplant or not.

We’ve mentioned the FLT 3 situation, and since we know that FLT3 is a bit of a worry because it’s associated with a higher risk of relapse.  There have been developments both pre-clinically and clinically over the years to develop inhibitors for this mutation.  None of them work very well for a long time if you just give them alone, so the name of the game is to add that to the chemotherapy you would be planning.  And at this ASH meeting this Midostaurin trial is the first randomised trial to show that doing this works.  There are other mutations for which there are inhibitors; sometimes the data is all very early, sometimes it looks quite encouraging but whether it really improves survival we don’t yet know.  But these studies are on the way.

In older patients there’s a challenge because of the risk of doing more harm to the patient with intensive chemo, and in addition the patients tend to have a leukaemia that is not inherently so responsive to chemo anyway.  So I think there’s a lot of interest in developing suitable treatments for older patients, say over the age of 70, which is where a large proportion of patients are, and here you’re wanting to have a drug that does not disturb the patient, that is effective and preferably is available in capsule or tablet form.  And there are one or two drugs of interest in this area.  And what is interesting I think in the last few years is that these are the patients where a lot of the focus on new drug development is taking place, which is good for the patients, because I think you know a number of new agents are going to be available to patients through these clinical trials.  Fifteen years ago these patients weren’t considered for clinical trials and the treatment was hardly, you know, it was just supportive care.   Now we’re moving on a wee bit, there’s a long way to go but there’s a lot of interest in developing new treatments in that group.

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.

View next