Intensive chemotherapy regimens and nonintensive treatment strategies in AML
Optimization of induction treatment in AML was the topic of the Joint Symposium organized together with the Korean Society of Hematology (KSH). In this session Professor Je-Hwan Lee (University of Ulsan, South Korea) discussed intensive chemotherapy regimens. Current intensive induction chemotherapy for AML is based on cytarabine and/or anthracyclines, and several studies have evaluated intensification of these regimens. In FLT3-mutated AML, high dose daunorubicin improved outcome. In this group combinations of intensive chemotherapy with FLT3 inhibitors are now being investigated. Chemotherapy may also be improved by using newer cytotoxic agents. Lee discussed clinical studies with two of these agents: CPX-351, a nano-scale liposomal formulation of cytarabine and daunorubicine; and gemtuzumab ozogamicine, an antibody-drug conjugate directed against CD33.
AML is a disease of the elderly, and many patients are ineligible for intensive chemotherapy. In the same Joint Symposium, Professor Gert Ossenkoppele (VU University Medical Center, Amsterdam, The Netherlands) addressed current and emergent nonintensive treatment strategies. Selection of patients for intensive chemotherapy requires a comprehensive approach, and should integrate comorbidities, physical and cognitive function, nutrition and social support. In addition to best supportive care, treatment options for unfit patients include epigenetic therapy with hypomethylating agents (decitabine, azacitidine) and non-intensive chemotherapy (low-dose cytarabine). Several recent studies aimed at improving these treatments evaluated the addition of targeted drugs, such as inhibitors of IDH1/2, BCL2, BTK, and HDAC.