Published: March 12, 2010
Risk Stratification Imperative to Treatment Selection in Patients with AML
HOLLYWOOD, Fla. - (BUSINESS WIRE) - Using risk stratification to assist in treatment selection was just one
of the focal points at a recent presentation of the NCCN
Clinical Practice Guidelines for Oncology (NCCN Guidelines )
for Acute Myeloid Leukemia (AML) at the NCCN 15th Annual
Conference. B. Douglas Smith, MD of The Sidney
Kimmel Comprehensive Cancer Center at Johns Hopkins and a member of
the NCCN Guidelines Panel for AML, spoke about the challenges in
treating AML as well as recent updates to the NCCN Guidelines .
Dr. Smith began with an overview on the demographics of AML stating that
there are more than 13,000 cases diagnosed annually and that incidence
exponentially increases with age.
"AML is a disease of older patients presenting a clinical challenge for
physicians since advances in therapy have been limited. Unfortunately,
many adults with acute leukemia, will die from their acute leukemia,"
said Dr. Smith.
Among prognostic factors in AML, cytogenetics, the chromosomal structure
of the leukemic cell, remains important.
"Cytogenetic analysis performed at diagnosis is widely recognized as one
of the most valuable prognostic indicators in AML. However, there is now
evolving data to support several important molecular markers that may
further define a patient's prognosis," said Dr. Smith.
Certain cytogenetic abnormalities are associated with very good
outcomes, while a number of other abnormalities are known to associate
with a poor prognosis and a high risk of relapse after treatment. About
half of all AML patients have "normal" cytogenetics and fall into an
intermediate risk group.
"Molecular markers are especially important to patients with normal
cytogenetics as traditional testing does not provide much insight into
their disease," said Dr. Smith.
Dr. Smith pointed to a portion of the NCCN
Guidelines that detail risk status based on cytogenetics
and molecular abnormalities.
Dr. Smith discussed additional updates to the most recent version of the
NCCN Guidelines including the addition of risk stratification, based on
white blood cell (WBC) count to assist with the selection of treatment
for patients with acute promyelocytic leukemia (APL), the most curable
subtype of AML.
"If physicians can better define the prognosis of an individual
patient's APL, they can more accurately develop a tailored treatment
plan for the patient," said Smith. "This may even allow physicians to
decrease the total amount of treatment a patient receives while
maintaining positive outcomes."
The NCCN Guidelines were expanded to distinguish the therapy options for
APL patients with low risk or high risk disease as defined by WBC count
status. The NCCN Guidelines recommend that patients with APL who can
tolerate anthracycline therapy should have their WBC count assessed
prior to therapy to classify them as high risk, which constitutes having
a WBC count greater or equal to 10,000, or low/intermediate risk, which
is having a WBC count of less than 10,000.
Smith stressed, "The NCCN Guidelines state that APL should be treated
according to one of the regimens established from clinical trials. The
panel strongly emphasizes the importance of using these regimens
consistently and not mixing induction from one with consolidation from
the other."
The treatment of AML in the elderly (>60 years) continues to be an unmet
need and a challenge Dr. Smith noted.
"Due to little progress being made in long-term survival rates of these
patients, the NCCN Guidelines recommend that patient performance status,
in addition to adverse features, comorbid conditions, and a patient's
chronological age, need to be considered when selecting treatment," said
Dr. Smith.
Additional therapies were recently added to the NCCN Guidelines based
upon clinical trial results including 5-azacytidine (Vidaza,
Celgene Corporation) and decitabine (Dacogen, Eisai Inc.),
as low intensity treatment options and clofarabine (Clolar,
Genzyme Corporation) as an intermediate intensity treatment option for
patients with AML who are 60 years or older. All these agents have a
category 2B designation.
In conclusion, Dr. Smith emphasized that ongoing clinical trials are
critically important for continued advancements in AML noting several
occurrences in the NCCN Guidelines that recommend referral to a clinical
trial.
The NCCN Guidelines are developed and updated through an evidence-based
process with explicit review of the scientific evidence integrated with
expert judgment by multidisciplinary panels of physicians from NCCN
Member Institutions. The most recent version of this and all the
NCCN Guidelines are available free of charge at NCCN.org.
About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network (NCCN®),
a not-for-profit alliance of 21 of the world's leading cancer centers,
is dedicated to improving the quality and effectiveness of care provided
to patients with cancer. Through the leadership and expertise of
clinical professionals at NCCN Member Institutions, NCCN develops
resources that present valuable information to the numerous stakeholders
in the health care delivery system. As the arbiter of high-quality
cancer care, NCCN promotes the importance of continuous quality
improvement and recognizes the significance of creating clinical
practice guidelines appropriate for use by patients, clinicians, and
other health care decision-makers. The primary goal of all NCCN
initiatives is to improve the quality, effectiveness, and efficiency of
oncology practice so patients can live better lives.
The NCCN Member Institutions are: City of Hope Comprehensive Cancer
Center, Los Angeles, CA; Dana-Farber/Brigham and Women's Cancer Center |
Massachusetts General Hospital Cancer Center, Boston, MA; Duke
Comprehensive Cancer Center, Durham, NC; Fox Chase Cancer Center,
Philadelphia, PA; Huntsman Cancer Institute at the University of Utah,
Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle
Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive
Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie
Comprehensive Cancer Center of Northwestern University, Chicago, IL;
Memorial Sloan-Kettering Cancer Center, New York, NY; H. Lee Moffitt
Cancer Center & Research Institute, Tampa, FL; The Ohio State University
Comprehensive Cancer Center - James Cancer Hospital and Solove Research
Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY;
Siteman Cancer Center at Barnes-Jewish Hospital and Washington
University School of Medicine, St. Louis, MO; St. Jude Children's
Research Hospital/University of Tennessee Cancer Institute, Memphis, TN;
Stanford Comprehensive Cancer Center, Stanford, CA; University of
Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UCSF
Helen Diller Family Comprehensive Cancer Center, San Francisco, CA;
University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; UNMC
Eppley Cancer Center at The Nebraska Medical Center, Omaha, NE; The
University of Texas M. D. Anderson Cancer Center, Houston, TX; and
Vanderbilt-Ingram Cancer Center, Nashville, TN.
For more information, visit NCCN.org.
NCCN
Megan Martin
610-550-1621
martin@nccn.org
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