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What Are the Current Treatment Options for AML?

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Published on April 3, 2019

During this “What Are the Current Treatment Options for AML?” full-length replay, Patient Power founder Andrew Schorr is joined by leading acute myeloid leukemia (AML) expert Dr. Uma Borate, from Oregon Health & Science University, Amanda Fowler, from The Leukemia & Lymphoma Society (LLS) and AML survivor Don Armstrong, to share exciting developments in treatment research and explain how these advances are impacting patients. The panel also discusses ways for patients and care partners to connect to financial and educational resources, emotional support and others on a similar journey. Watch now to hear both expert and patient perspectives on the ever-evolving landscape of AML care.

This is a Patient Empowerment Network program in partnership with The Leukemia & Lymphoma Society produced by Patient Power. We thank Celgene, Daiichi Sankyo, Jazz Pharmaceuticals and Novartis for their support.

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Transcript | What Are the Current Treatment Options for AML?

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:
And greetings from Los Angeles.  I'm Andrew Schorr.  Welcome to this Patient Empowerment Network program produced in association with The Leukemia & Lymphoma Society and with support from the following companies:  Celgene, Daiichi Sankyo, Jazz Pharmaceuticals and Novartis.  We thank them for their support, but be advised no outside party has any editorial control. 

In this program, we're going to discuss the latest treatments for acute myeloid leukemia.  We have a wonderful panel, and over the next hour we will be discussing the options. But, of course, always discuss this with a healthcare team that you trust, so you get the care that's right for you or a loved one.  Also, if you have a question, send it in to [email protected], [email protected], and we'll get to questions as we can. 

Today with us with have with us a pretty long-term survivor of AML joining us, and we also have an information specialist from the Leukemia & Lymphoma Society and a noted physician researcher from Oregon Health & Science University.  So let's go around the country and meet them.  I'm in Los Angeles. 

Let's go to Fort Worth, Texas, and joining us now is Don Armstrong, who was treated for AML.  Gee, Don, in 2005 your whole world turned upside down, right? 

Don Armstrong:
It absolutely did.  September of 2005 I had no idea there was anything wrong with me until I had a couple ladies tell me on a Friday afternoon I looked horrible.  That ultimately led me to see my general practitioner, and a couple of days later I was diagnosed with acute myeloid leukemia, and from there right into the hospital, right into treatment.

Andrew Schorr:
Right.  And you were in the hospital for a long time. 

Don Armstrong:
I was.  I was in the hospital the first time for 33 days. 

Andrew Schorr:
Wow.  And ultimately you had a transplant, which is one of the approaches still for AML, and you survived.

Don Armstrong:
I did.  I did.  Yeah, it was interesting.  That first couple of days in the hospital there was so much activity going on around, we and I couldn't understand why I was getting so much attention until one of the nurses kind of pulled me aside and said, you understand you've got a 25 to 30 percent chance of surviving this type of leukemia, don't you?  And I said, now I do, yes.  So it was quite a shock to the system, and it was something that—you just have to kind of hang on and just go with the program as much as you can. 

Andrew Schorr:
And a shock to the family.  I mean, it's a family affair. 

Don Armstrong:
No question about it.  Whenever you're diagnosed with cancer, no matter what the cancer is, it's just not you.  The entire family is involved.  And I had a great support system.  My dad and my brother and my sister came from different parts of the country just to be with me and support me.  I had an unbelievable group of family and friends that were there with me every single day. 

Andrew Schorr:
And you had a transplant.  Where did the donor cells come from that sort of rebooted your immune system? 

Don Armstrong:
That's a great question.  I'm actually currently still looking for my donor.  My donor, he was happy.  I know he's a male.  He was excited that he was able to help me, but I have never able to connect with him.  I'm trying again.  I just—so through the Be the Match I got my stem cells, and fortunately there was someone there that was willing to give my life a second chance. 

Andrew Schorr:
Now, Don is very active with The Leukemia & Lymphoma Society, which is a partner in this program.  Don, you've spent many years now, your career has been in golf, and you were a golf superintendent, and yes, you sprayed pesticides on the golf course.  You're devoted to giving back.  Talk then a little bit about that and what you try to tell patients and families, so they can get through this hopefully successfully, as you have. 

Don Armstrong:
You know, like we had talked about, I had no idea there was anything wrong with me when I found out I had leukemia, and I was in for a pretty big fight of my life.  After five rounds of chemo and a stem cell transplant, making it through that, I felt like I had been given a second chance, so I wanted to find a way to give back.  And I found The Leukemia & Lymphoma Society.  I found one of their campaigns, Team in Training.  Started doing the endurance events and raising money for that organization.  Just did my 2015 retraining event, but through it all I really wasn't doing it just to run a marathon.  I was doing it to raise money for research so that somebody else hopefully didn't have to go through what I went through.  So for me that was a big shift in my mindset.  That eventually led me into being a part of the board of trustees, and I continued along that line.  And I try to stay up on as much about AML as I can, and I talk to as many patients around the country as I can whenever I'm given the opportunity. 

Andrew Schorr:
Well, you're going to hear a lot today, and research has paid off.  Let's go up to Colorado outside Denver where Amanda Fowler is an Information Specialist with The Leukemia & Lymphoma Society.  And that means if you call, and I urge you to, whether a patient or a family member, they can help because based on research the world of AML has changed significantly and gives people a great deal more help and is changing those statistics that Don talked about.  Amanda, welcome to the program. 

Amanda Fowler:
Thank you so much for having me. 

Andrew Schorr:
So I'm right.  Research has been paying off just in the last year or two and even with more research coming our way, right? 

Amanda Fowler:
It's incredible.  There have been drug approvals in the last two years.  There are numerous clinical trials.  We are really seeing AML treatment change for the better at a pretty rapid pace right now. 

Andrew Schorr:
Okay.  So just to be clear, if someone who is watching now calls The Leukemia Society like the national number, and maybe you can tell us again, how do they get to you so you can help them sort this out? 

Amanda Fowler:
Absolutely.  It's really easy to reach an Information Specialist.  We are open 9 a.m. to 9 p.m. Eastern time and our number, which we can repeat at any time, is 1-800-955-4572, and that will take you straight to an Information Specialist.  And once you reach us we're really there to talk and figure out exactly what you need. 

So if you're not sure if you need help or not, give us a call anyway, and we can go over a lot of the resources and services from psychosocial support to financial resources, disease education.  We have a clinical trial support center, so a whole variety of resources, and we encourage people when in doubt to reach out to us. 

Andrew Schorr:
Okay.  All right.  Let's hear about the research.  So joining us from Portland, Oregon, at Oregon Health & Science University is Dr. Uma Borate, who is a hematologist-oncologist.  Dr. Borate, thanks for being with us. 

Dr. Borate:
Absolutely.  Thank you for having me. 

Andrew Schorr:
Okay.  So we've alluded to changes in AML, payoffs in research.  You're still in the lab moving research forward with your peers around the world.  You all are making progress, am I right?  The world and the options, the combinations, things you're researching, that's all changing incredibly fast. 

Dr. Borate:
It absolutely is.  And I just wanted to first just appreciate Don and his journey because we see patients like him every day, and we deliver these very shocking and stressful diagnoses to patients and kind of see the journey of absorbing what this means for them.  The family rallying around them.  And then the treatment and the eventual, you know, the role that takes them hopefully to a cure.  And I just—every day when I talk to my patients I just applaud their courage.  So, Don, I just wanted to put that out there.  You guys are awesome. 

With that said, I think in the last I would say four to five years, and Amanda can attest to this, we've had over nine FDA-approved therapies for AML after about four decades of no progress.  And a lot of this has come with discoveries in the lab where we have identified specific genes that have had genetic changes, what we call genetic mutations, that lead to a patient developing AML. 

And now we have what we call targeted therapies where we can target that specific genetic mutation and therefore destroy the AML cells in a way that doesn't expose the patient to a lot of additional toxicities.  However, for a certain subset of the AML patients, like Don, we know that these targeted therapies can work for a while, but if you are going for what we call a curative active therapy, for a lot of patients transplant is still right now one of the most, I think, advocated and proven curative therapies out there. 

Andrew Schorr:
Okay.  So let's talk about testing.  So somebody is diagnosed with AML.  What should happen now so that you as a specialist, the doctor, the team that they see, they know what version of AML you have and whether it matches up with either one of these approved therapies or maybe something you at an academic medical center are researching that could be the drug of tomorrow? 

Dr. Borate:
So I think that's a great question, and for patients or family members or anybody else listening out there I think what you a alluded to as the most crucial step in the diagnosis of AML and the subtype of AML is the testing.  So as soon as we identify a patient, like Don described, typically it's, you know, you don't feel well.  You go to somebody, they say, oh, my God, your blood work doesn't look right.  You go to another doctor. 

The first thing that we ask that happens is when a bone marrow biopsy, which is the diagnostic procedure that gives you the diagnosis of AML is done, that it be subjected to adequate genetic testing.  And by this I mean there are many, many laboratories out there that do what we call expanded genetic mutational panels, and they test for all the different genes that could have a mutation that potentially could be targeted or make the patient a candidate for a clinical trial in the future. 

The Leukemia & Lymphoma Society is sponsoring an extremely revolutionary clinical trial called BDML, which we are a part of, which does this testing and returns the results back to the clinical provider or the physician in seven days, which is really unheard of in terms of a timeline.  This used to take about two weeks on average. 

And so in seven days, I know all the genetic changes in my patient's leukemia, and I can determine, hey, is this the right therapy for them?  Should they go on a clinical trial that we have?  And BDML offers several of what we call sub-studies that are used to match them to the appropriate clinical trial or the appropriate drug.

Andrew Schorr:
Okay.  So, Amanda, let's talk about this for a second.  So, oh, my God, a patient is diagnosed with this acute condition.  Don found himself in the hospital right away, and I understand there can be different versions of AML.  Some like do not pass go, boom, you're going to the emergency room at the hospital right away, or some there's a little more time.  But a call comes to you, and people want to feel confident that where they are or where—do they go to this hospital or that hospital, this clinic or that one.  They get someone who is knowledgeable when the whole world of AML has been changing. 

So how do you counsel people so they get the right testing and just all the range of options are considered for them? 

Amanda Fowler:
Sure.  Absolutely.  So I should say a lot of the calls, particularly for the acute leukemias, actually come not from the patient but from the caregiver.  The patient is often sick and overwhelmed, and it's a family member who is making the calls.  Of course, we are having to talk to both the patient or the caregiver, but it is really important to be at a center of excellence for this diagnosis. 

Not all hospitals are equipped to handle AML.  If you're lucky, a local hospital will see that and send you on to the bigger center, but sometimes that work does fall on the family member.  We recommend that people go to university-type settings or National Cancer Institute comprehensive cancer centers.  These are going to be the larger hospitals that understand what tests are involved.  They will have clinical trials as options, and they will be knowledgeable on the latest treatment options.

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