'The HemOnc Pulse' Live 2024 in Chicago: AML Unanswered Questions

“The HemOnc Pulse” goes on the road to Chicago May 3-4 with host Chadi Nabhan, MD, MBA, FACP, for the first live meeting.

This podcast episode features a panel discussion on unanswered questions in acute myeloid leukemia (AML) with Naval Daver, MD, an Associate Professor in the Department of Leukemia at the University of Texas MD Anderson Cancer Center; Sanam Loghavi, MD, an Associate Professor of Pathology at MD Anderson Cancer Center; Rami Komrokji, MD, Vice-Chair of the Malignant Hematology Department at Moffitt Cancer Center; and Mikkael Sekeres, MD, a Professor of Medicine and Chief of the Division of Hematology at the Sylvester Comprehensive Cancer Center at University of Miami Health.

To kick off the session, Dr. Sekeres questioned the value of FLT3 inhibitors during induction, the postremission setting, and the maintenance setting.

“There’s an uncomfortable truth about them, which is that the complete response rates are the same upfront whether you get an FLT3 inhibitor or not. Is that really a benefit?” he asked. “We have data showing that there is a deeper measurable residual disease (MRD) status for patients who do get the FLT3 inhibitors upfront.”

Dr. Loghavi discussed MRD as a prognostic tool in AML. “Not all MRD is created equal,” she said. “Not all the assays are equally sensitive. You really have to know what you’re using and how to interpret the data in the context of the greater picture.”

Using MRD to decide on transplant for patients is a reasonable approach, Dr. Komrokji added.

He also highlighted the question of defining the line between myelodysplastic syndromes and AML. “It’s a continuing disease,” he said. “We have so many active therapies targeted that we really should not be caught in that arbitrary line.”

One of the challenges in practice is how to treat patients in the gray zone, Dr. Komrokji added. “Most of the patients we see in practice could be candidates for intensive chemotherapy versus targeted therapy,” he said.  “That’s an individualized discussion with every patient.”

The panel also discussed whether chemotherapy is still needed in 2024, the risks versus benefits of azacitidine plus venetoclax, and challenging the definition of therapy-related AML.