Discover and read the best of Twitter Threads about #AMLsm
Most recents (4)
At @ASH_hematology #ASH22 highlights I am being told some transplanters are refusing to do #AlloHSCT for otherwise eligible #AMLSm younger pts in CR because of bialleic #TP53 +MRD, I don’t think this is acceptable. Counsel on poor outcomes but there is a tail at end of OS curve
Even if it 10%. I anecdotally had few pts who lived for years post transplant going in with TP53 bialleic complex type & MRD+ CR. I don’t think you should deprive pt only possibly of cure just to try to eradicate pre-allo MRD which often does not occur with any pre-transplant tx
Give MAC & throw in early maintenance & hope GVL effect kicks in before relapse. We have to be humble about how we council using data. Encourage trials of novel agents, counsel patients honestly, if older pt who can’t get MAC then maybe discourage transplant not in younger pt
#tweetorial 🧵
🚩Metabolism and Acute Myeloid Leukemia
(1/23)
➡️📈🔎Increased attention over the last decade on the metabolic perturbations in AML
➡️Potential therapeutic implications – with ‘druggable’ targets
🚩Metabolism and Acute Myeloid Leukemia
(1/23)
➡️📈🔎Increased attention over the last decade on the metabolic perturbations in AML
➡️Potential therapeutic implications – with ‘druggable’ targets
(2/23)
➡️🗒️📌Summary of recent concepts
🔊IT IS ALL HAPPENING IN THE MITOCHONDRIA
👉📈🏹Increase potential of targeting the mitochondria
👉🦀Anti-cancer agents specifically targeting cancer cell mitochondria are referred to as 'mitocans'
➡️🗒️📌Summary of recent concepts
🔊IT IS ALL HAPPENING IN THE MITOCHONDRIA
👉📈🏹Increase potential of targeting the mitochondria
👉🦀Anti-cancer agents specifically targeting cancer cell mitochondria are referred to as 'mitocans'
(3/23)
➡️Metabolic adaptions of AML cells
AML is a 🦀cancer derived from the myeloid lineage of blood🩸cells, characterized by overproduction of malignant cells.
➡️Metabolic adaptions of AML cells
AML is a 🦀cancer derived from the myeloid lineage of blood🩸cells, characterized by overproduction of malignant cells.
#tweetorial 🧵
➡️Ph-like ALL / BCR-ABL1-like ALL
👉A provisional entity in the 2016 World Health Organization classification of acute leukemia 🩸🩸
👉Gene expression 🧬signature similar to Ph-positive ALL but lacks the BCR-ABL1 translocation
@NancyArthurPhD
➡️Ph-like ALL / BCR-ABL1-like ALL
👉A provisional entity in the 2016 World Health Organization classification of acute leukemia 🩸🩸
👉Gene expression 🧬signature similar to Ph-positive ALL but lacks the BCR-ABL1 translocation
@NancyArthurPhD
➡️Originally defined by gene expression 🧬profiling in 2009 by 2 groups
👉Children's Oncology Group (COG) and St. Jude Children's Research Hospital (referred to as Ph-like ALL) 👉Dutch Childhood Oncology Group (referred to as BCR-ABL1-like ALL) – DCOG/COALL
👉Children's Oncology Group (COG) and St. Jude Children's Research Hospital (referred to as Ph-like ALL) 👉Dutch Childhood Oncology Group (referred to as BCR-ABL1-like ALL) – DCOG/COALL
👉The differences in the approaches are outlined in the figure; more on the gene expression 🧬 signatures and diagnostic conundrums later!
PART 3! If you’re not sold on moderately intensive chemo, outcomes with HMA +/- ven also rival outcomes with CPX-351 in sAML. One could argue the control group in the CPX-351 paper should have been hypomethylating agent-based regimens!
CR/CRi rates with 10-d decitabine are consistently >50%, irrespective of sAML, age, and cytogenetics. Median OS in Blum, PNAS 2010 ~13 months. pnas.org/content/107/16…
Whether venetoclax adds anything to this remains to be seen. In the phase I/II study of HMA+ven, CR/CRi in elderly sAML was 67%, median OS NR. Wait for the phase III before you make any conclusions #oncstewardship #anothertweetorial? ncbi.nlm.nih.gov/pubmed/30361262
