Over the past several years, drug approvals for first-line treatment of acute myeloid leukemia have changed the landscape from a “wasteland” to an “embarrassment of riches.” In general, patients deemed “fit” for induction chemotherapy who have a core-binding factor abnormality should receive 7 + 3 in combination with gemtuzumab, 7 + 3 with midostaurin for those with an FLT3 abnormality, and liposomal cytarabine + daunorubicin for patients with secondary AML. Although other options exist, Dr. Daniel A. Pollyea recommended a venetoclax/azacitidine regimen for newly diagnosed “unfit” patients. Future research should focus on more clearly determining the definition of a “fit” patient, he said at the NCCN 2019 Annual Congress: Hematologic Malignancies.
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Daniel A. Pollyea
Presenter: Daniel A. Pollyea
The “Age of Induction” led to breakthroughs in the treatment landscape for acute myeloid leukemia (AML), and was immediately followed by a long period during which few drugs were approved. That all changed a few years ago, when 2017 began the “Age of Abundance.” With many treatment options now available, new management strategies have emerged for patients with secondary AML, as well as for older patients with AML. Treatment can now be tailored to these special populations, and providers should be aware of the unique supportive care considerations associated with these newer AML therapies.
Daniel A. Pollyea, Jessica K. Altman, Rita Assi, Dale Bixby, Amir T. Fathi, James M. Foran, Ivana Gojo, Aric C. Hall, Brian A. Jonas, Ashwin Kishtagari, Jeffrey Lancet, Lori Maness, James Mangan, Gabriel Mannis, Guido Marcucci, Alice Mims, Kelsey Moriarty, Moaath Mustafa Ali, Jadee Neff, Reza Nejati, Rebecca Olin, Mary-Elizabeth Percival, Alexander Perl, Amanda Przespolewski, Dinesh Rao, Farhad Ravandi, Rory Shallis, Paul J. Shami, Eytan Stein, Richard M. Stone, Kendra Sweet, Swapna Thota, Geoffrey Uy, Pankit Vachhani, Carly J. Cassara, Deborah A. Freedman-Cass, and Katie Stehman
Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy characterized by the clonal expansion of myeloid blasts in the peripheral blood, bone marrow, and/or other tissues. It is the most common form of acute leukemia among adults and accounts for the largest number of annual deaths from leukemias in the United States. Like AML, blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a myeloid malignancy. It is a rare malignancy characterized by the aggressive proliferation of precursors of plasmacytoid dendritic cells that frequently involves the bone marrow, skin, central nervous system, and other organs and tissues. This discussion section focuses on the diagnosis and management of BPDCN as outlined in the NCCN Guidelines for AML.
Brady L. Stein, Jason Gotlib, Murat Arcasoy, Marie Huong Nguyen, Neil Shah, Alison Moliterno, Catriona Jamieson, Daniel A. Pollyea, Bart Scott, Martha Wadleigh, Ross Levine, Rami Komrokji, Rebecca Klisovic, Krishna Gundabolu, Patricia Kropf, Meir Wetzler, Stephen T. Oh, Raul Ribeiro, Rita Paschal, Sanjay Mohan, Nikolai Podoltsev, Josef Prchal, Moshe Talpaz, David Snyder, Srdan Verstovsek, and Ruben A. Mesa
The classical Philadelphia chromosome–negative myeloproliferative neoplasms (MPN), which include essential thrombocythemia, polycythemia vera, and myelofibrosis (MF), are in a new era of molecular diagnosis, ushered in by the identification of the JAK2V617F and cMPL mutations in 2005 and 2006, respectively, and the CALR mutations in 2013. Coupled with increased knowledge of disease pathogenesis and refined diagnostic criteria and prognostic scoring systems, a more nuanced appreciation has emerged of the burden of MPN in the United States, including the prevalence, symptom burden, and impact on quality of life. Biological advances in MPN have translated into the rapid development of novel therapeutics, culminating in the approval of the first treatment for MF, the JAK1/JAK2 inhibitor ruxolitinib. However, certain practical aspects of care, such as those regarding diagnosis, prevention of vascular events, choice of cytoreductive agent, and planning for therapies, present challenges for hematologists/oncologists, and are discussed in this article.
NCCN Guidelines Insights: Acute Myeloid Leukemia, Version 2.2021
Featured Updates to the NCCN Guidelines
Daniel A. Pollyea, Dale Bixby, Alexander Perl, Vijaya Raj Bhatt, Jessica K. Altman, Frederick R. Appelbaum, Marcos de Lima, Amir T. Fathi, James M. Foran, Ivana Gojo, Aric C. Hall, Meagan Jacoby, Jeffrey Lancet, Gabriel Mannis, Guido Marcucci, Michael G. Martin, Alice Mims, Jadee Neff, Reza Nejati, Rebecca Olin, Mary-Elizabeth Percival, Thomas Prebet, Amanda Przespolewski, Dinesh Rao, Farhad Ravandi-Kashani, Paul J. Shami, Richard M. Stone, Stephen A. Strickland, Kendra Sweet, Pankit Vachhani, Matthew Wieduwilt, Kristina M. Gregory, Ndiya Ogba, and Martin S. Tallman
The NCCN Guidelines for Acute Myeloid Leukemia (AML) provide recommendations for the diagnosis and treatment of adults with AML based on clinical trials that have led to significant improvements in treatment, or have yielded new information regarding factors with prognostic importance, and are intended to aid physicians with clinical decision-making. These NCCN Guidelines Insights focus on recent select updates to the NCCN Guidelines, including familial genetic alterations in AML, postinduction or postremission treatment strategies in low-risk acute promyelocytic leukemia or favorable-risk AML, principles surrounding the use of venetoclax-based therapies, and considerations for patients who prefer not to receive blood transfusions during treatment.