Acute Leukemias | Alexander Perl, MD

published 1 month ago by Dr Neil Love

Acute Leukemias Update, Issue 1, 2020 — Part 1: Our interview with Dr Perl highlights the following topics as well as cases from his practice: Case: A woman in her early 70s with a history of triple-negative breast cancer receives venetoclax/azacitidine for secondary acute myeloid leukemia (AML) (00:00) Nonspecific symptoms of AML at initial diagnosis (02:11) Efficacy and safety of liposomal cytarabine/daunorubicin (CPX-351) in older patients with newly diagnosed AML (04:02) Essential diagnostic workup and genetic testing in AML: Consideration of disease characteristics in treatment decision-making (06:09) Differentiating therapy-related AML; treatment outcomes in patients with unfavorable, complex or monosomal karyotypes (09:25) Prior treatments that increase the risk of therapy-related AML; factors to consider in selecting intensive versus nonintensive treatment for therapy-related disease (11:48) Considering patient needs and preferences in choosing intensive versus nonintensive treatment (16:15) Potential cure rates for patients with AML in different clinical scenarios (20:05) Diagnostic workup for AML; importance of genetic alterations in treatment selection (23:05) Workup for intermediate- or favorable-risk karyotypes to guide the decision to use gemtuzumab ozogamicin in AML (27:11) Integrating the FDA reapproved agent gemtuzumab ozogamicin into therapy for AML: Outcomes from the Phase III ALFA-0701 trial (29:10) Role of the hedgehog inhibitor glasdegib in front-line therapy for patients with AML not eligible for intensive induction chemotherapy (30:44) Treatment of AML with venetoclax and a hypomethylating agent: Considerations for optimizing therapeutic benefit (33:57) Prevention of tumor lysis syndrome in patients with AML receiving venetoclax-based therapy (36:03) Efficacy of front-line venetoclax/azacitidine for AML (37:36) Age- and fitness-based risk-benefit assessment when determining whether to administer venetoclax/azacitidine to patients with AML (42:08) Monitoring for and mitigation of tumor lysis syndrome associated with venetoclax/azacitidine (43:59) Management of myelosuppression associated with venetoclax in combination with a hypomethylating agent (47:08) Case: A man in his mid-20s presents with hyperplasia, leukocytosis and fatigue and is diagnosed with AML with a FLT3 mutation (49:24) Efficacy and safety results from the Phase III ADMIRAL trial of gilteritinib for relapsed or refractory AML; potential for moving gilteritinib into earlier lines of therapy (53:44) FLT3 inhibitors as maintenance therapy: Optimal duration, quality of life and the ongoing Phase III BMT CTN 1506 trial (58:30) Outcomes with gilteritinib as front-line therapy for AML with a FLT3 mutation (1:01:49) Treatment options for older patients with AML with FLT3 mutations who are not candidates for intensive therapy (1:03:48) Evidence supporting the use of IDH inhibitors for older patients with AML with IDH1/2 mutations (1:09:22) Evolving treatment landscape in acute lymphoblastic leukemia (ALL); management paradigm for ALL in younger versus older patients or those with Philadelphia chromosome-positive disease (1:13:02) Efficacy and safety of the bispecific T-cell engager blinatumomab as a salvage therapy option for relapsed or refractory ALL (1:18:34) Chimeric antigen receptor (CAR) T-cell therapies in the third-line setting for patients with relapsed or refractory ALL: Efficacy outcomes and tolerability (1:22:18) FDA approval of tisagenlecleucel for ALL; perspective on improving T-cell persistence and overcoming resistance to CAR T-cell therapy (1:25:29) CME information and select publications

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