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What Strategies Are Used to Treat Relapsed AML?

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Published on February 14, 2020

Key Takeaways

  • An individual patient may have multiple different clones with different mutations within the AML.
  • If a patient comes out of AML remission, genomic profiling of the relapsed sample is recommended. 

Acute myeloid leukemia experts Dr. Pinkal Desai, from Weill Cornell Medical College, and Dr. Tapan Kadia, from The University of Texas MD Anderson Cancer Center, discuss the value of genomic profiling after relapse to help determine next steps in care. Watch as both Dr. Desai and Dr. Kadia explain the heterogeneity of AML and how a patient’s mutational status can change over time.

This is a Patient Empowerment Network program produced by Patient Power. We thank Astellas, Celgene Corporation, Daiichi Sankyo and Jazz Pharmaceuticals for their support. These organizations have no editorial control. Patient Power is solely responsible for program content.

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Transcript | What Strategies Are Used to Treat Relapsed 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.

Andrew Schorr:            

Now, it seems you have more tools to get people in remission, but how do you sustain that remission, or if they come out of that remission, do you do something different then? Dr. Desai?

Dr. Desai:                     

So, if patients do come out of remission, then depending on what the situation is, if they were transplanted previously or not, that is taken into consideration. If the patient was not transplanted earlier, then the goal is to put the patient back into remission, and then consider a transplant, but when somebody relapses, it’s a little—it may be different than the original leukemia, so we advocate doing a genomic profiling of the relapsed sample again, even though the original sample, we already know, and most of the time, it’s similar, but we do find that there may be more mutations that have now come up, and that would be important because now, we have all this—so many tools in our bag, so we want to choose. 

It’s almost the same as the up-front management that we choose depending on their genomic profile what they’ve had before in terms of treatment and whether they’ve been transplanted or not. We make a decision on what treatment would be best at this point to maximize the chance of remission again.

Andrew Schorr:            

Okay. So, Dr. Kadia, you tell me if I’ve got this right from what Dr. Desai just said. In other words, cancer can change. These karyotypes, or whatever you’re talking about—the genes that went awry and are driving your cancer—there may be different cancer genes driving it the second time around, if you will, and you need to take a look at that to see would a different medicine or a different combination make sense, right?

Dr. Kadia:    

Absolutely. So, it goes a little bit also back to the heterogeneity of AML. We talked about heterogeneity among patients, where maybe another patient may have a different version of AML, but even within an individual patient, when you say you have a clone of AML, you may actually have multiple different clones with different mutations within the AML. Now, at the time of diagnosis, one of those clones may be completely dominant. 

So, if you had a bunch of Skittles—maybe you have in your bone marrow all green Skittles and a couple of purple Skittles, and you kill off the dominant leukemia—the green leukemia, the green Skittles – but maybe a year or two later, that purple leukemia, which was resistant to the therapy you gave, is now the dominant clone and has relapsed.

And so, what Dr. Desai was pointing out is absolutely correct. At the time of relapse, you want to make sure that the clone that has relapsed—is it, in fact, the same clone that you treated three months ago, six months ago, a year ago, or has that clone now been treated, but there’s a new clone arising that’s related to the other clone? The reason that’s important is because if that clone now has a new mutation or abnormality that you can target potentially better with a new agent, then you could potentially try to use that. So, I think that’s an important point to re-characterize the leukemia at the time of 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.

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