Progress toward Better Treatment of Therapy-Related AML.
Angeliki KotsiaftiKonstantinos GiannakasPanagiotis ChristoforouKonstantinos LiapisPublished in: Cancers (2023)
Therapy-related acute myeloid leukemia (t-AML) comprises 10-20% of all newly diagnosed cases of AML and is related to previous use of chemotherapy or ionizing radiotherapy for an unrelated malignant non-myeloid disorder or autoimmune disease. Classic examples include alkylating agents and topoisomerase II inhibitors, whereas newer targeted therapies such as poly (adenosine diphosphate-ribose) polymerase (PARP) inhibitors have emerged as causative agents. Typically, t-AML is characterized by adverse karyotypic abnormalities and molecular lesions that confer a poor prognosis. Nevertheless, there are also cases of t-AML without poor-risk features. The management of these patients remains controversial. We describe the causes and pathophysiology of t-AML, putting emphasis on its mutational heterogeneity, and present recent advances in its treatment including CPX-351, hypomethylating agent plus venetoclax combination, and novel, molecularly targeted agents that promise to improve the cure rates. Evidence supporting personalized medicine for patients with t-AML is presented, as well as the authors' clinical recommendations.
Keyphrases
- acute myeloid leukemia
- newly diagnosed
- allogeneic hematopoietic stem cell transplantation
- poor prognosis
- end stage renal disease
- chronic kidney disease
- long non coding rna
- machine learning
- early stage
- radiation induced
- radiation therapy
- stem cells
- big data
- clinical practice
- emergency department
- drug delivery
- acute lymphoblastic leukemia
- cell therapy
- cancer therapy
- immune response
- patient reported
- oxidative stress
- adverse drug