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What to Consider When Starting AML Treatment

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Published on February 14, 2018

With a moving target like AML, who should patients consult with? What factors are taken into account when making AML treatment decisions? Watch now to find out from AML experts, Dr. Lee Greenberger from The Leukemia & Lymphoma Society and Dr. Amit Verma from Montefiore Medical Center, what conversations with a healthcare team about treatment should entail in order to receive the most effective AML therapy.

This is a Patient Empowerment Network program produced by Patient Power, in partnership with The Leukemia & Lymphoma Society (LLS). We thank Astellas, Celgene Corporation, Novartis, Pfizer and Seattle Genetics for their support.

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Transcript | What to Consider When Starting AML Treatment

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. Greenberger, AML is a moving target now, right?  I mean, both you and Dr. Verma have mentioned about drug approvals, new names we're starting to hear and others that are in the lab, so it would seem like have some consultation or having your local doctor consult with a Dr. Verma for instance, that maybe is really important because this target is changing all the time, right? 

Dr. Greenberger:

Right. So that, and the research is getting—is improving.  I'd say it's improving much faster now than it was 10 years ago.  We have experimental drugs that patients could go on clinical trials.  And which mutation you have and what drugs are available and what the performance of those drugs are in the clinical trials, as Kuldip just mentioned, knowing people and physicians who are working in those trials to know what are the most promising drugs out there if you needed to get on those clinical trials and hopefully get better results.

Andrew Schorr:

So, Dr. Verma, let's talk about that.  So if research is proceeding and some later?stage research that you may be involved in as well, and then you have some newly approved drugs, part of the discussion with a patient who comes to you is based on your tests here's what I have that's approved, here's what I have in research.  Let's see how that matches up including the research protocols with your situation and make a decision together.  In other words, the clinical trial discussion may be part of the initial discussion, right?

Dr. Verma:

Yes, absolutely.  So, you know, we—the fact that we are doing the mutations is for a reason.  We want to use that information to guide the decisions that are tailor?made for each individual case.  You know, I give you some examples.  You know, there is this gene called p53, and this is mutated in about, I would say, 10, sometimes 15 percent of patients with acute myeloid leukemia.  And when this gene is mutated the effectiveness of traditional chemotherapy goes down.  And there has been emerging data from clinical trials that agents like azacitidine (Vidaza) and decitabine (Dacogen) may be more effective when you have mutation in the P53 gene.  

So for example a patient comes with acute myeloid leukemia, and the patient is elderly and has a p53 gene mutation, he might not elect to use the conventional chemotherapy for that particular case.  And we usually see if there is a clinical trial for which the patient qualifies, which will provide them with either azacitidine or decitabine alone or in combination with another agent which has shown exciting preclinical—meaning in the lab—data or in small early?phase clinical trials.  And we would like to maybe treat the patient with that particular therapy rather than just cookie?cutter conventional chemotherapy. 

So we look not just at the mutations, and we look at the overall performance status, how well the patient is doing, have they had any other chemotherapies for other cancers in the past, have they, you know—do they have other organ system issues.  So you take a holistic view of the patient.  You combine it with the mutational data and then decide. 

You know, another important consideration is, especially patients with AML, if they have any younger or, you know, siblings, that can be potentially tested for matches for a possible bone marrow transplant.  Because if you have certain high?risk mutations and the chances of relapse are higher after therapy, you preemptively want to plan to do an allogeneic bone marrow transplant after the patient goes into remission, because the thinking is that there may be the chances of a relapse after some time. 

So you as soon as you have the patient in remission, if we are lucky enough to get a good match, it could be a related match or an unrelated match, we would then like to proceed with the transplant.  So there are a few decisions to be made, and genetic testing helps in all of them. 

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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