ASH 2025 | Selecting between triplet combinations and intensive chemotherapy in AML

I think it does depend a little bit on what kind of mutations the patient has and as well as the patient’s fitness. I think what’s being increasingly apparent with triplet combinations is that patient selection is very important. Now you want to hit the sweet spot between patients who are not eligible for intensive chemotherapy because let’s be clear that is the standard of care for patients with AML but in patients who are not eligible for intensive chemotherapy, because let’s be clear, that is the standard of care for patients with AML. But in patients who are not fit for intensive chemotherapy, who are fit enough to have three agents, then triplet therapy would be very appropriate for these patients. There is a planned randomized clinical trial for patients in that kind of borderline zone between triplet therapy and intensive chemotherapy to see what is best for these patients. But in terms of patient selection and trying to figure out what’s best for them, I think it would also depend on the targeted therapies available and the mutations that a patient has. So if a patient had NPM1 and FLT3-ITD, for example, then the question is, do you choose between a menin inhibitor and a FLT3 inhibitor? I think that’s an important question. I think if the FLT3 burden was very high, I would probably opt for a FLT3 inhibitor. But say, for example, a patient with KMT2A rearrangement, then a menin inhibitor would be very important based on the data that we’re seeing.

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