Acute Myeloid Leukemia - Episode 1

Case 1: FLT3+ AML

June 19, 2019

EXPERT PERSPECTIVE VIRTUAL TUMOR BOARD

Naval G. Daver, MD:Thank you for joining us for thisTargeted OncologyVirtual Tumor Board®, which is focused on Acute Myeloid Leukemia. In today’sTargetedOncology Virtual Tumor Board®presentation, my colleagues and I will review 4 clinical cases. We will discuss an individualized approach to treatment for each patient and will review key trial data that impact our decisions.

I am Dr Naval Daver, associate professor in the Leukemia Department at the [University of Texas] MD Anderson Cancer Center in Houston, Texas.

Today I’m joined by:

Dr James McCloskey, chief of the Division of Leukemia and member of the Adult Blood and Marrow Stem Cell Transplantation Program at the John Theurer Cancer Center of Hackensack University Medical Center in Hackensack, New Jersey.

Dr David Rizzieri, professor of medicine, chief of the Section of Hematological Malignancies, and associate director for clinical research in the Division of Hematological Malignancies and Cellular Therapy at Duke Cancer Institute in Durham, North Carolina.

Dr Olga Weinberg, director of hematopathology and flow cytometry in the Department of Pathology and assistant professor of pathology at the Boston Children’s Hospital and Brigham and Women’s [Hospital] Harvard Medical School in Boston, Massachusetts.

And, Dr Usama Gergis, associate professor of clinical medicine in the Division of Hematology and Medical Oncology at the Weill Cornell Medical Center in New York, New York.

Thank you for joining us. Let’s get started with our first case.

Dr McCloskey, if you would like to discuss our first case, which is aFLT3-mutated acute myeloid leukemia, please take it away.

James K. McCloskey II, MD:Thank you. Our first case today is a 44-year-old woman who comes in to her primary care physician with flu-like symptoms and fatigue that she says have been present for around 2 weeks. Prior to this,­­ she was healthy and had no remarkable past medical history. Upon work-up, the primary care doctor notices that her WBC [white blood cell count] is elevated—it’s 65,000 white blood cells—and they know that there are blasts observed in circulation. The patient is thrombocytopenic with a platelet count of 45,000, anemic with a hemoglobin of 10, and borderline neutropenic with a neutrophil count of 1.1. Her other [laboratory results] are fairly unremarkable. She has normal liver and kidney function, and her cardiac [examination] is also normal, including an echocardiogram that shows an intact ejection fraction.

The patient undergoes a bone marrow biopsy that shows 65% blasts. Her cytogenetics returned and these are normal. Molecular testing is sent and confirms the presence of anNPM1mutation. The patient is also noted to have aFLT3ITD [internal tandem duplication] mutation present at a low level with an allelic burden of .28. In addition to these, mutations are observed inTP53andASXL1, andRUNX1is noted to be wild type.

Transcript edited for clarity.