Dr Juckett on the Evolving Treatment Paradigm in Relapsed/Refractory AML

Mark Juckett, MD, professor, medicine, Division of Hematology, Oncology, and Transplantation, the University of Minnesota Medical School, discusses ways the treatment paradigm has changed for patients with relapsed/refractory acute myeloid leukemia (AML), highlighting key differences between historical AML management strategies and novel treatment approaches with the potential to change practice in the future.

In the contemporary era, the management of relapsed/refractory AML has evolved significantly, Juckett says. Previously, the clinical course was more straightforward, with clear distinctions between patients who responded to upfront treatment and those who did not respond and eventually relapsed, Juckett notes. However, individual AML cases have become more nuanced, Juckett notes. Patients may achieve morphologic remission but still exhibit minimal residual disease according to molecular testing results, indicating a higher relapse risk and raising questions about subsequent treatment strategies, Juckett explains.

Current treatment approaches also include less intensive therapies, such as hypomethylating agents combined with venetoclax (Venclexta), which can prolong and maintain quality of life without necessarily generating complete responses (CR), Juckett emphasizes. Therefore, challenges exist when approaching the treatment of patients who achieve partial responses but not CRs, according to Juckett. Additionally, patients who do not achieve remission with these less intensive regimens will eventually experience disease progression and require alternative treatment methods, Juckett reports.

The AML treatment paradigm is further complicated by the emergence of novel agents that hold promise for managing AML more tolerably, potentially shifting the field toward viewing AML as a chronic disease, Juckett adds. This approach to treatment contrasts with traditional aggressive therapies, highlighting the need for a re-evaluation of long-term AML management strategies, Juckett says.

Simultaneously, advancements in transplantation have made aggressive treatment options more effective and less toxic, enabling their use in patients older than 70 years of age, Juckett explains. Overall, this progress prompts questions about optimal AML management strategies, Juckett concludes.