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Flow Cytometry to Estimate Leukemia Stem Cells in Primary Acute Myeloid Leukemia and in Patient-derived-xenografts, at Diagnosis and Follow Up
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Challenges in the diagnosis and treatment of secondary acute myeloid leukemia

Gert Ossenkoppele1, Pau Montesinos2

  • 1VU University Medical Center, 2PK Brug 016, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.

Critical Reviews in Oncology/Hematology
|May 17, 2019
PubMed

Insights

Secondary AML (sAML), a challenging leukemia subtype, historically shows poor outcomes. Novel therapies like CPX-351 offer improved front-line treatment options for older adults with high-risk sAML.

Area of Science:

  • Hematology
  • Oncology
  • Pharmacology

Background:

  • Secondary acute myeloid leukemia (sAML), including therapy-related AML (tAML) and AML with myelodysplasia-related changes (AML-MRC), represents a significant portion of AML cases (10%-30%).
  • sAML is characterized by a poor prognosis, particularly in older adults, with historically suboptimal outcomes using conventional chemotherapy regimens.
  • Current treatment strategies for sAML include intensive chemotherapy (e.g., 7+3) or less aggressive options for elderly or unfit patients, but efficacy remains limited.

Purpose of the Study:

  • To review the current understanding of secondary AML (sAML) diagnosis and treatment strategies.
  • To highlight the efficacy of novel therapeutic approaches, specifically CPX-351, in improving outcomes for patients with high-risk sAML.
  • To emphasize the need for optimized diagnostic and therapeutic paradigms for sAML to enhance patient survival and quality of life.

Main Methods:

  • Literature review of secondary AML (sAML) classification, treatment history, and emerging therapies.
  • Analysis of clinical trial data and treatment guidelines pertaining to sAML management.
  • Focus on the role of CPX-351, a liposomal formulation of cytarabine and daunorubicin, in the context of sAML treatment.

Main Results:

  • CPX-351 has demonstrated improved front-line outcomes in older patients diagnosed with high-risk sAML.
  • CPX-351 is approved for adults with newly diagnosed therapy-related AML (tAML) or AML with myelodysplasia-related changes (AML-MRC).
  • The National Comprehensive Cancer Network (NCCN) guidelines recommend CPX-351 as a Category 1 option for induction therapy in patients over 60 with high-risk sAML.

Conclusions:

  • CPX-351 represents a significant advancement in the front-line treatment of older adults with high-risk secondary AML.
  • While CPX-351 shows promise, further research into optimal diagnostic criteria and novel therapies for specific sAML subgroups is warranted.
  • Improving the management of sAML requires a comprehensive approach, integrating diagnostic clarity with effective therapeutic strategies to enhance outcomes in this vulnerable patient population.
Keywords:
AML-MRCDiagnosisSecondary AMLTherapyTherapy-related AML

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