The past three years have witnessed remarkable progress in acute myeloid leukemia (AML). The approval and development of targeted therapies and novel agents has improved outcomes for patients with ...traditionally poor survival rates. This review has summarized the survival impact of chemotherapy-based regimens in AML and described recent advances that will be of significance in the near future.
To advance this cooperation, in November, 2021, the Rambam Health Care Campus, a tertiary-care, academic, governmental medical centre in Haifa in the north of Israel, launched a mission to bridge the ...gap between Israeli and Palestinian communities and offer services, including paediatric and adult haemato–oncological services, to Palestinian patients from both Gaza and the West Bank. Severely ill patients were referred to the Rambam Health Care Campus by their local treating physicians for therapeutic modalities that were unavailable in Gaza and the West Bank. 34 paediatric patients (aged 2 months to 13 years) and 84 adults (aged 16–74 years), mainly with life-threatening diseases, such as acute leukaemia and bone marrow failure, received medical care at our institution. 15 paediatric and 48 adult patients underwent the most comprehensive medical treatments, including allogeneic stem-cell transplantation and novel immunotherapies. Apart from medical care, we have taken upon ourselves the task to address a broad array of other needs not otherwise covered for this population, such as food, housing, clothing, and medically necessary health care of their accompanying family members, transportation from checkpoints to the hospital and back, religious services, and free-time activities for the younger patients. ...with the aim of providing autonomy in health care to the highest degree, we provided residency and fellowship-level training to Palestinian physicians in Gaza and the West Bank.
Although the majority of adult patients with both acute lymphoblastic leukemia and acute myelogenous leukemia achieve remission with upfront chemotherapy, many patients still suffer relapse. Often, ...the strategy is proposed of treating patients with relapsed leukemia into a second remission (CR2) and then proceeding to allogeneic transplantation as the definitive curative approach. However, the long-term outcomes of such a strategy are poor: the 5-year overall survival from first relapse for patients with acute leukemia is only approximately 10%. This Perspective highlights the fact that most patients do not achieve CR2 and therefore never really have an opportunity for a potential curative therapy. Although patients who undergo transplantation after relapse may be cured, those who do not achieve CR2 are rarely candidates for transplantation; therefore, the overall outcome for patients who relapse is dismal. There is therefore an urgent need not only for more effective upfront therapy to prevent relapse, but also for the development of therapies that can serve as effective bridging treatments between relapse and transplantation. We suggest that more optimal use of minimal residual disease detection during first remission may also improve the chances for successful transplantation therapy via earlier reinduction therapy, allowing transplantation before overt relapse.
Despite living in an era of unprecedented progress in the understanding of the genetic and molecular biology of acute myeloid leukemia (AML), this has not translated into significant advances in ...therapy. Never before have so many potential targets been studied. Yet most have not advanced beyond the phase 1 and, occasionally, phase 2 studies. The few ongoing phase 3 studies seem unlikely to have more than a marginal benefit, if at all. Thus, it is not surprising that in past few decades almost no new drugs for AML have received regulatory approval. In 2000, gemtuzumab ozogamicin (GO) was granted accelerated approval by the US Food and Drug Administration based on promising phase 2 data in relapsed older adults with AML. GO held promise as a new agent that also could be efficacious in newly diagnosed AML with acceptable toxicity. Several phase 3 studies were designed to test GO in this setting. The results of a randomized study by the Southwest Oncology Group led in 2010 to the voluntary withdrawal of this agent when improved efficacy could not be demonstrated and toxicity appeared excessive. Since then, 4 randomized studies have been completed that, in aggregate, strongly support the efficacy of this agent in newly diagnosed AML with acceptable toxicity. There is a very plausible explanation for this discrepancy, making a compelling case for reapproval of GO in AML.
Will new agents impact survival in AML? Rowe, Jacob M.
Best practice & research. Clinical haematology,
December 2019, 2019-12-00, 20191201, Letnik:
32, Številka:
4
Journal Article
Recenzirano
In recent years, several drugs—including midostaurin, gilteritinib, and gemtuzumab ozogamicin, to name a few—have been approved or reapproved in the United States to treat patients with acute myeloid ...leukemia (AML). Yet survival rates for younger patients had improved with chemotherapy alone even before the approvals of these new agents. This begs the question whether the new therapies will actually have a positive impact on survival. The 5-year survival rate for older patients has also risen, again without the addition of these new agents. The challenge will be to incorporate new therapies and use them where they will have the greatest impact—major work for clinicians and researchers alike.
Summary
Treatment of acute lymphoblastic leukaemia (ALL) in adults presents a formidable challenge. While overall results have improved over the past 3 decades, the long‐term survival for patients ...aged less than 60 years is only in the range of 30–40% and is 10–15% if between 60 and 70 years and <5% for those over 70 years. The historic lack of clear‐cut biological prognostic factors has led to over‐ or under‐treatment of some patients. Response to initial therapy is an important prognosticator of outcome based on disease biology, as well as pharmacogenetics, which include the patient’s response to drugs given. The more widespread availability of allogeneic transplantation and reduced‐intensity regimens for older patients have opened up this curative modality to a greater number of patients. Hopefully, those options, as well as novel cytogenetic and molecular markers, will enable a better selection of patients who undergo intensive therapies and finally break the 30–40% cure barrier for adults with ALL.
There has been remarkable progress in the treatment of acute myeloid leukemia (AML) which has spanned 5 decades. The changing trends have led to new approaches and significant improvement in ...outcomes. This review has summarized the historical insights that have shaped the current treatment paradigms of AML.
PDF
