Siddhartha Mukherjee, MD, explains the current golden standard for frontline treatment of patients with acute myeloid leukemia.
Siddhartha Mukherjee, MD, assistant professor of medicine at Columbia University Medical Center, explains the current golden standard for frontline treatment of patients with acute myeloid leukemia (AML).
Targeted therapies have allowed investigators to address the unique genetic makeup in select patients with AML. In recent years, clinical trials have evaluated chimeric antigen receptor (CAR) T-cell therapy approaches for the treatment of patients with this disease. With this, multiple agents have revealed promising results in a variety of hematologic malignancies, including within AML studies.
Currently, there are 2-3 targeted therapies available for genetic mutations, including 1 for patients who are positive for FLT3 mutations, and IDH inhibitors for patients that harbor mutations in the IDH gene. Still, for patients with relapsed/refractory AML, enrollment in a clinical trial and allogeneic transplantation remain the core ways of treatment.
0:08 | First, the thing to know about AML is that it's a very heterogeneous disease. The first thing we try to do is to subdivide patient populations based on their risk, if they're low-risk, intermediate-risk, or high-risk. These are defined by gene sequencing. Patients who are low-risk generally tend to respond better to chemotherapy. Patients who are intermediate-/high-risk generally tend to respond poorly to chemotherapy, and of course, those with high-risk disease respond extremely poorly to chemotherapy. Therefore, those low-risk patients are usually treated with chemotherapy upfront. High-risk patients are generally treated with a directionality towards allogeneic transplantation, and with intermediate-risk patients it's at the physician’s discretion.
1:20 | There are 2 or 3 targeted therapies that are available for genetic mutations One of them would be for patients who are positive for FLT3 mutations, and midostaurin [Rydapt] is 1 therapy available for them. Then, some patients have mutations in the IDH gene, and again, there are some IDH inhibitors available for them. That's been the standard of therapy for the frontline.