How to address second and therapy-related acute myelogenous leukaemia.
Caspian OliaiGary SchillerPublished in: British journal of haematology (2020)
Secondary acute myelogenous leukaemia (AML), as compared to de novo AML, occurs in the more elderly population, is independently more resistant to cytotoxic chemotherapy, has a higher relapse rate, and a worse prognosis. Secondary AML (sAML) is a heterogeneous disease, both biologically and clinically, even within the World Health Organization subgroups of sAML. Outcomes are the poorest in subgroups with sAML arising from an antecedent haematologic disorder which has been previously treated (ts-AML), and sAML in patients <55 years of age. This review describes the suboptimal outcomes of contemporary therapy, to support the notion of an unmet need for innovative treatment strategies in sAML. Despite the recent approval of CPX-351, long-term outcomes for this high-risk disease remain dismal. Resistance mechanisms to intensive chemotherapy contribute to relapse. Targeted immune therapy may avoid multidrug resistance mechanisms, but are unlikely to provide long-term remission due to a complex and rapidly evolving clonal disease profile. Advances for sAML will likely be accomplished by CAR T cell therapy or bispecific antibodies providing a bridge to allogeneic stem cell transplantation. Therefore, focus should be placed on novel strategies that can augment the untargeted effector function of allogeneic grafts.
Keyphrases
- stem cell transplantation
- cell therapy
- acute myeloid leukemia
- high dose
- liver failure
- allogeneic hematopoietic stem cell transplantation
- stem cells
- bone marrow
- squamous cell carcinoma
- mass spectrometry
- dendritic cells
- type diabetes
- locally advanced
- rheumatoid arthritis
- aortic dissection
- low dose
- adipose tissue
- middle aged
- disease activity
- regulatory t cells
- patient reported outcomes
- insulin resistance
- acute respiratory distress syndrome
- chemotherapy induced
- patient reported