Thread by @Berninini

PART 1 - Background. Vyxeos is the “winner” of the first #oncstewardship #tweetorial! There are some serious flaws in the Vyxeos data. First let’s define Secondary AML (sAML)

sAML can be divided into AML that has evolved from an antecedent heme disorder (AHD), or therapy-related AML (tAML). Per WHO, AML with myelodysplasia-related changes (AML-MRC) also includes those with MDS-related cytogenetic abnormalities and those with multilineage dysplasia

Classic agents that lead to tAML are:
1⃣XRT/alkylating agents➡️longer time to AML development (5-7 yrs)➡️associated w/ MDS-like monosomal karyotypes (deletion 5 or 7)
2⃣Topo II inhibitors➡️shorter latency (1-3 yrs)➡️associated w/KMT2A rearrangements (MLL, 11q23)
#boardquestion

Outcomes in sAML are worse than a Game of Thrones character. A Danish population study demonstrated long-term OS rates are ~5-20% in patients receiving intensive induction (e.g. 7+3)(Granfeldt Østgård, et al. JCO. 2015). CR rates were also not optimal (54-61% in all pts).

As such, there was no “standard of care” for secondary AML. Goal has been remission ASAP, then alloHCT. Some use 7+3 (see above), some use less “intense” strategies with similar CR/less toxicity (e.g., hypomethylating agents, FLAG, CLAG, etc.). /End PART 1