TY - JOUR
T1 - How I treat acute myeloid leukemia in the era of new drugs
AU - DiNardo, Courtney D.
AU - Wei, Andrew H.
N1 - Funding Information:
A.H.W. is the recipient of a Medical Research Future Fund Fellowship and receives funding support from the National Health and Medical Research Council of Australia, the Victorian Cancer Agency, the Australian Cancer Research Foundation, and the Leukemia & Lymphoma Society Specialized Centre of Research (SCOR-Strasser) and Equity Trustees. C.D.D. is the recipient of the Lloyd Family/V Foundation Clinical Scholar Award.
Publisher Copyright:
© 2020 by The American Society of Hematology
PY - 2020/1/9
Y1 - 2020/1/9
N2 - The acute myeloid leukemia (AML) treatment landscape has changed substantially since 2017. New targeted drugs have emerged, including venetoclax to target B-cell lymphoma 2, midostaurin and gilteritinib to target FLT3, and ivosidenib and enasidenib to target mutant isocitrate dehydrogenase 1 and 2, respectively. Other additions include reapproval of gemtuzumab ozogomycin to target CD33, glasdegib to target the hedgehog pathway, and a liposomal formulation of daunorubicin and cytarabine (CPX-351). Genomically heterogeneous AML has a tendency to evolve, particularly under selective treatment pressure. For decades, treatment decisions have largely centered around chemotherapy drug intensity. Physicians now have access to an increasing number of drugs with novel mechanisms of action and distinctive side-effect profiles. Key issues faced by hematologists in this era of new drugs include (1) the timely identification of actionable mutations at diagnosis and at relapse; (2) deciding which drug to use among several therapeutic options; and (3) increasing awareness of how to anticipate, mitigate, and manage common complications associated with these new agents. This article will use 3 case presentations to discuss some of the new treatment challenges encountered in AML management, with the goal of providing practical guidance to aid the practicing physician.
AB - The acute myeloid leukemia (AML) treatment landscape has changed substantially since 2017. New targeted drugs have emerged, including venetoclax to target B-cell lymphoma 2, midostaurin and gilteritinib to target FLT3, and ivosidenib and enasidenib to target mutant isocitrate dehydrogenase 1 and 2, respectively. Other additions include reapproval of gemtuzumab ozogomycin to target CD33, glasdegib to target the hedgehog pathway, and a liposomal formulation of daunorubicin and cytarabine (CPX-351). Genomically heterogeneous AML has a tendency to evolve, particularly under selective treatment pressure. For decades, treatment decisions have largely centered around chemotherapy drug intensity. Physicians now have access to an increasing number of drugs with novel mechanisms of action and distinctive side-effect profiles. Key issues faced by hematologists in this era of new drugs include (1) the timely identification of actionable mutations at diagnosis and at relapse; (2) deciding which drug to use among several therapeutic options; and (3) increasing awareness of how to anticipate, mitigate, and manage common complications associated with these new agents. This article will use 3 case presentations to discuss some of the new treatment challenges encountered in AML management, with the goal of providing practical guidance to aid the practicing physician.
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U2 - 10.1182/blood.2019001239
DO - 10.1182/blood.2019001239
M3 - Article
C2 - 31765470
AN - SCOPUS:85077761236
SN - 0006-4971
VL - 135
SP - 85
EP - 96
JO - Blood
JF - Blood
IS - 2
ER -