Leukemia

Those with chronic graft-versus-host-disease who have received allogeneic hematopoietic stem cell transplant may experience enhanced graft-versus-leukemia effects, thus producing a lower relapse rate in acute myeloid leukemia.

In this Cancer Network Around the Practice program, Mazie Tsang, MD offers an overview of the current landscape surrounding frontline therapy in CLL.

Treatment with lisocabtagene maraleucel in the TRANSCEND CLL 004 study raises no new safety concerns in patients with relapsed/refractory chronic lymphocytic leukemia, says Tatyana Feldman, MD.

A medical oncologist reviews clinical trial data for revumenib and ziftomenib for patients with relapsed/refractory acute myeloid leukemia.

Asciminib results in greater efficacy, safety, and tolerability compared with bosutinib in patients with chronic myeloid leukemia, according to findings from the phase 3 ASCEMBL study.

Ghayas C. Issa, MD, discusses the pathway between KMT2A rearrangements/NPM1 and menin in relation to leukemia cells and how these genetic abnormalities impact prognosis.

Ibrutinib plus venetoclax appears to be effective across the overall chronic lymphocytic leukemia population in the CAPTIVATE study, although progression-free survival is shorter for those with TP53 mutations.

Revumenib treatment results in durable MRD-negative remissions in pediatric and adult patients with relapsed/refractory KMT2A rearranged acute leukemia in the phase 2 Augment-101 study.

Acalabrutinib on its own or in combination with obinutuzumab increases PFS and ORR in patients with chronic lymphocytic leukemia regardless of mutation status, according to follow-up data from the ELEVATE-TN trial.

Patients with NPM1-mutated acute monocytic leukemia who are minimal residual disease negative do not appear to benefit from allogeneic stem cell transplant after chemotherapy induction, even with a FLT3 ITD co-mutation.

When used as a minimal residual disease (MRD)–guided treatment approach, ibrutinib (Imbruvica) combined with venetoclax (Venclexta) improved progression-free and overall survival (OS) compared with fludarabine, cyclophosphamide, and rituximab (Rituxan; FCR) in patients with treatment-naive chronic lymphocytic leukemia (CLL), as observed in the phase 3 FLAIR trial.

Treatment outcomes with obecabtagene autoleucel in patients with relapsed/refractory B-cell acute lymphoblastic leukemia appear to be better in those with lower leukemia burden at lymphodepletion in the FELIX study.

Data from the phase 1/2 BRUIN study support continuous BTK pathway inhibition as an important sequencing approach in chronic lymphocytic leukemia or small lymphocytic lymphoma, says Jennifer A. Woyach, MD.

Treatment with zanubrutinib also appears to improve overall survival compared with ibrutinib among patients with relapsed/refractory chronic lymphocytic leukemia or small lymphocytic lymphoma in the phase 3 ALPINE trial.

Treatment with venetoclax appears to be well-tolerated in patients with chronic lymphocytic leukemia or small lymphocytic lymphoma, says Nilanjan Ghosh, MD, PhD.

Results from the phase 1/2 SAVE trial demonstrated an improved objective response rate when revumenib was added to decitabine/cedazuridine, and venetoclax for patients with relapsed/refractory acute myeloid leukemia.

Patients with promyelocytic leukemia saw an improved overall survival and relapse-free survival when treated with an all-oral regimen of arsenic trioxide, all-trans retinoic acid, and ascorbic acid.

An expert on acute myeloid leukemia gives an overview of disease subtypes and provides insights on risk stratification.

Ghayas C. Issa, MD, describes the typical presentation of patients with acute myeloid leukemia and provides clinical insights on evaluating response and potential disease progression.

Treatment with blinatumomab or inotuzumab ozogamicin particularly confers higher total costs for patients with relapsed/refractory B-cell acute lymphoblastic leukemia.

The safety profile of venetoclax following allogeneic hematopoietic stem cell transplantation in patients with chronic lymphocytic leukemia appears to be comparable with other reports in clinical trials.

Patients with chronic lymphocytic leukemia and small lymphocytic lymphoma can now receive treatment with pirtobrutinib.

Safety data from the phase 3 PREVAPIX-ALL trial support the use of apixaban among pediatric patients with acute lymphoblastic leukemia who are at high risk of thrombosis.

Data from the phase 2 FELIX study support the biologics license application for obecabtagene autoleucel as a treatment for patients with relapsed/refractory acute lymphoblastic leukemia.

Concluding their discussion, Drs Advani, Parrondo, and Chanan-Khan conclude that second-generation BTK inhibitors are the preferred first-line treatment in patients with chronic lymphocytic leukemia due to better efficacy and lower cardiovascular risk, with emerging therapies promising even better outcomes.

Doctors discuss that while cardiovascular side effects like atrial fibrillation and hypertension in patients with chronic lymphocytic leukemia are concerns with BTK inhibitors, they are manageable and should not deter prescribing these effective therapies; generally, atrial fibrillation is considered more challenging to manage than hypertension.

Ricardo Parrondo, MD, explains that different BTK inhibitors have varying rates of cardiovascular side effects in patients with chronic lymphocytic leukemia, suggesting the choice between them should consider a patient's preexisting cardiovascular conditions, with acalabrutinib favored for hypertension concerns and zanubrutinib for atrial fibrillation issues.

Ricardo Parrondo, MD, discusses that in treating chronic lymphocytic leukemia, BTK inhibitors like ibrutinib can pose cardiovascular risks, including hypertension; he suggests that in choosing a BTK inhibitor one should consider the patient's preexisting cardiovascular conditions.

Asher A. Chanan-Khan, MBBS, MD, led a panel discussion surround the use of Bruton tyrosine kinase inhibitors for patients with chronic lymphocytic leukemia.

Karmanos Cancer Institute and Cleveland Clinic gave presentations regarding treatment of multiple myeloma and chronic myeloid leukemia in the latest Face Off.