FEATURES
New Treatment Options
Lead to New Questions in
Acute Myeloid Leukemia
For the past 40 years, the standard remission induction
treatment for patients with newly diagnosed acute myeloid
leukemia (AML) who are candidates for intensive therapy has
been a combination of two types of chemotherapy: cytara-
bine and an anthracycline antibiotic, most often daunorubi-
cin. The combination is known as “7+3,” in reference to the
seven days during which patients receive cytarabine and the
three days during which they receive the anthracycline. Both
agents prevent DNA replication, while the anthracycline also
inhibits the ability of cells to repair deleterious double-
stranded breaks in DNA.
For patients who can tolerate it, 7+3 provides a 40- to
70-percent chance of achieving complete remission (CR).
Consolidation therapy depends on the risk of disease return;
typically, favorable-risk patients receive about three months of
high-dose cytarabine, while those at higher relapse risk are of-
fered an allogeneic hematopoietic cell transplantation (AHCT)
from a healthy donor to improve the rate of durable remission.
The 7+3 regimen is still a mainstay of therapy; however, in
part due to an increased understanding of AML biology, there
have been eight new therapies approved by the U.S. Food and
Drug Administration (FDA) to treat AML since 2017. Some of
the new therapies are intended for use in combination with
the standard induction chemotherapy, others replace the 7+3
regimen, and others still are options for those patients whose
disease comes back or is refractory to initial treatments.
“There is a definite excitement in AML over the new
therapy options. We have had so many years without a real
improvement that having eight newly approved drugs – and
additional ones likely to be approved soon – makes this an
absolutely exciting time in AML,” Gail Roboz, MD, from Weill
Cornell Medicine/New York-Presbyterian Hospital, told ASH
Clinical News. Dr. Roboz also directs Weill Cornell’s Clinical
and Translational Leukemia Program.
But she acknowledged that the availability of these ther-
apies has made the treatment decisions more complicated:
While the new drugs have increased CR rates, the rates of
overall and progression-free survival are still similar to those
associated with older treatment options.
“These drugs are not home runs,” said Laura Michaelis, MD,
from the Division of Hematology and Oncology at the Medical
College of Wisconsin. “We still need to improve the median
survival by quite a lot. Even with these newer agents, we are still
sending many people to transplant for the chance of a cure.”
ASH Clinical News spoke with Drs. Roboz, Michaelis, and
other clinical researchers about the recently approved thera-
pies for AML and how clinicians are incorporating them into
their treatment regimens.
May 2019
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