IACH Focus on Leukemia 2020 | The 2020 highlights in acute leukemias
Arnon Nagler, MD, Chaim Sheba Medical Center, Tel-Aviv, Israel, discusses the recent developments in treatment for acute leukemias. The FDA and EMA have recently approved 8 new drugs for treating acute myeloid leukemia (AML). The 8 drugs range from monoclonal antibodies, IDH2 inhibitors and targeted therapy in an induction and maintenance setting. There has also been progress in immunotherapy for acute lymphoblastic leukemia (ALL). There are 2 monoclonal antibodies used to treat ALL, as well as CAR T-cells, which have produced good results. In AML, there has been some progress in immunotherapy, specifically anti-CD33 molecules. There is also data emerging for the use of CAR T-cells and anti-2A2G molecules in AML. This interview took place during the 2020 Annual Meeting of the International Academy for Clinical Hematology (IACH).
Transcript (edited for clarity)
I co-chaired the International Academy of Clinical Hematology virtual meeting, focusing on AML, with Professor Mohamad Mohty. This is the third annual meeting of International Academy of Clinical Hematology, and we focus this year on AML. The reason is that AML, acute myeloblastic leukemia, is a lethal disease. There was very little progress in the last 30 years, especially in elderly patients, so patient above the age of 65, and the median age of AML patient is about 70, 72...
I co-chaired the International Academy of Clinical Hematology virtual meeting, focusing on AML, with Professor Mohamad Mohty. This is the third annual meeting of International Academy of Clinical Hematology, and we focus this year on AML. The reason is that AML, acute myeloblastic leukemia, is a lethal disease. There was very little progress in the last 30 years, especially in elderly patients, so patient above the age of 65, and the median age of AML patient is about 70, 72. And also in high-risk disease. The mortality is very high even if in the good risk AML, like core-binding factor, the mortality is life for 10 years, 50%. In overall, only 20% of the patients will be alive after 10 years, or even less.
Luckily enough, in the last three years, both the FDA and EMA have approved eight new drugs in AML, based on the signal conduction and mechanism of the leukemogenesis in the blast. They approved two FLT3 inhibitors, they approved monoclonal antibody against CD33. They approved anti-BCL2 drug, in combination with hypomethylating agent or LDAraC, HDAC inhibitors and IDH1 and IDH2 inhibitor. So today we have a lot to offer our patients with the drug design or targeted therapy, which we can give both in the induction, as well as in maintenance therapy post-transplantation, and that our data is that these inhibitors or new drugs improve a subset of patient that has the mutation, or for instance with anti-CD33, in patient we see good risk and intermediate-risk AML. So this is a huge development in AML, and this was the highlight.
Of course, besides the pharmacologic progress, there is also the aspect of immunotherapy. Immunotherapy until recent years in AML was only allogeneic transplantation, or donor lymphocyte infusion. But a first in acute lymphoblastic leukemia, we have now two monoclonal antibodies that are very efficient and they induce a measurable residual disease negativity pre-transplantation. So beside chemotherapy for adult ALL, it’s a really devastating disease, we have two monoclonal antibody and we have the CAR T-cells.
Chimeric Antigen Receptor T-cells, which are working nice in ALL. And also in AML, there is some progress in regard to immunotherapy, I already mentioned the anti CD33 antibody, but there are some emerging data, beginning of data of CAR T cells, against 2G2A and CD123, and other molecules. So there is a lot of progress in AML in the last few years, and the most importantly, a hope to our patients. And this is a really exciting time for acute leukemia, both ALL, and now also AML, and we give hope to our patients.
Read more...
