Treatment Options and Care for Patients Who Develop Therapy-Related AML - Episode 2

AML: Surveillance and Concerns With Previous Treatment

Rami Komrokji, MD:For lymphomas, in general, we conduct surveillance in terms of 2 aspects: one is to look at the disease itself and its recurrence, and the second is to look at the short- and long-term side effects. For the disease itself, the guidelines suggest seeing the patients on a regular basis and doing a physical exam. There is controversy about the value of repeating tests like a PET scan or CAT scans after the first couple of years. They may not be indicated. So, there is a surveillance related to the disease itself. There is also a surveillance related to the complications, short term and long term, of the treatment. Again, the rate of therapy-related AML, or the incidence, is low, but it’s probably fair enough to have some surveillance with blood counts on a regular basis, with annual visits down the road. You should keep that in mind. That’s a possibility. Obviously, there are other things that one could look into based on a clinical presentation, such as the development of congestive heart failure from treatment for lymphoma.

With CHOP chemotherapy, the short-term toxicities during treatment may include myelosuppression, the development of febrile neutropenia, complications related to the therapy, and the development of congestive heart failure. In the long term, with this particular therapy for lymphoma, one would worry about the development of therapy-related AML or MDS.

Nowadays, we combine CHOP with rituximab for lymphoma patients as a curative treatment. Most of the time, we are able to cure those diffuse large B-cell lymphomas. Then we deal with the sequelae of some of the treatments. In the long term, although the incidence is low, therapy-related AML or MDS is the one that we worry about.

Transcript edited for clarity.

Case: A 67-Year-Old Man with Therapy-Related AML

  • A 67-year-old man who had received CHOP for diffuse large B-cell lymphoma 3 years prior
  • PMH: hypertension controlled with amlodipine
  • Laboratory results:
    • WBC 15 x 109/L
    • Serum creatinine 1.5 mg/dL
    • Normal LFTs
    • LVEF 50%
  • Diagnosis: Acute Myeloid Leukemia
  • ECOG PS 1
  • The patient received liposomal cytarabine and daunorubicin
  • His course was complicated by febrile neutropenia
  • After induction, <5% marrow blasts, neutrophil count (>1400/&micro;L), platelets 60,000/&micro;L