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Doctor, Could I See the Menu, Please?

December 12, 2021

From Molecular Fine Dining to Personalized Drug Smorgasbords: We’re Serving Up the Bread and Butter of Acute Myeloid Leukemia Sessions  

Natasha Szuber, MSc, MD

Dr. Natasha Szuber (@NatashaSzuber) is a hematologist-oncologist at Maisonneuve-Rosemont Hospital, University of Montreal in Quebec, Canada, specializing in myeloid disorders, particularly myeloproliferative neoplasms, and has further interests in clonal hematopoiesis and iron metabolism. She received her MSc at McGill University in Montreal, her MD at University of Montreal, and did her Advanced Hematology Myeloid Fellowship at Mayo Clinic in Rochester, Minnesota. Dr. Szuber remarked that she was “born, raised, and currently still residing in Montreal…It's a beautiful, vibrant city if you can look past the orange construction cones and innumerable potholes!” 

While Dr. Szuber is “relatively new” to the ASH family, she is looking forward to collaborating further in coming years and was just selected to participate in the ASH Clinical Research Training Institute this year. Fun fact: Dr. Szuber enjoyed a “past life as an aspiring rock n' roll star, recorded three albums, and toured with my band across Canada before finally surrendering to the call to med school.” 

 

We’ve all been there. The buffet. Donning your most socially appropriate stretchy pants, you stand back and take it all in: the enticing aromas, the steam coming off the military-sized stainless steel warming trays, the rows of unidentifiable meats cloaked in multihued sauces. And with a stomach pleading for peristalsis, you feast. While there are a few unspoken codes to chowing down at the all-you-can-eat refectories (eat the good stuff first, don’t fill up on water…), we often leave riddled with regret wondering if we should’ve planned things out a little better and been a bit more selective. Was it imperative for me to try those little brown thingamajigs that looked like sausages? Maybe I should have left some of the orange chicken for the other diners? The fact is, as much as we all want to spread that $18.99 as far as it can go, the real rules of the buffet should be: keep a varied plate and a firm-but-flexible plan. When choosing acute myeloid leukemia session offerings at the ASH annual meeting — a veritable hematologic “buffet” microcosm — one might also abide by these gastronomic-inspired guidelines. Furthermore, now benefitting from data on clonal expansion, epigenetic modification, and high-level multi-omics to direct and refine therapeutics, our tastebuds have evolved, and we have officially traded in the buffet for a meticulously selected à-la-carte menu for every fussy appetite, curious craving, and dietary restriction. Consider it hand-picked, artisanal pharmacotherapeutics — made-to-order, drug-to-table. To help serve you, we have curated a menu of fundamental science, translational research, real-world clinical data, and everything in between as you savor the Michelin-star quality banquet that awaits.  

Our starter is the oral session “Acute Myeloid Leukemia [AML]: Biology, Cytogenetics, and Molecular Markers in Diagnosis and Prognosis” taking place on Sunday, December 12, at 4:30 p.m. Eastern time (ET). It boasts a cornucopia of offerings. Of note, from an AML biology perspective, Dr. Jasmine Naru will present “Proteogenomic Characterization of Highly Enriched Viable Leukemic Blasts in AML: A SWOG Report,” describing the use of an integrated, multi-omics platform exploiting proteomics and RNA sequencing to detect novel protein biomarkers in undifferentiated viable leukemic blasts (uVLBs) of patients with AML. Results unveil uVLBs proteomes as a unique source of prognostic biomarkers and potentially actionable neoantigens that may be targeted through innovative therapies. 

Next under the cloche, on Monday, December 13, at 5:45 p.m. ET, Dr. Hartmut Döhner will be presenting outcomes from the QUAZAR AML-001 trial in his talk titled, “Prognostic Impact of NPM1 and FLT3 Mutations at Diagnosis and Presence of measurable Residual Disease (MRD) After Intensive Chemotherapy (IC) for Patients With Acute Myeloid Leukemia (AML) in Remission: Outcomes From the QUAZAR AML-001 Trial of Oral Azacitidine (Oral-AZA) Maintenance.” Another must-sample session will be Dr. Pau Montesinos’ highly anticipated report on the AGILE trial, “AGILE: A Global, Randomized, Double-Blind, Phase 3 Study of Ivosidenib + Azacitidine Versus Placebo + Azacitidine in Patients with Newly Diagnosed Acute Myeloid Leukemia with an IDH1 Mutation,” scheduled for Monday, December 13, at 2:45 p.m. ET. This randomized phase III, double-blind study evaluated oral IDH1 inhibitor ivosidenib plus AZA versus placebo plus AZA in patients with newly diagnosed AML ineligible for intensive chemotherapy. The primary endpoint was event-free survival with key secondary endpoints including clinical response and overall survival. The results are noteworthy and provide an exciting new avenue for an otherwise difficult-to-treat AML sub-population. Cultivating the theme of targeted therapy, in the FLT3-mutated population, oral session “A Triplet Combination of Azacitidine, Venetoclax and Gilteritinib for Patients with FLT3-Mutated Acute Myeloid Leukemia: Results from a Phase I/II Study,” presented by Dr. Nicholas J. Short on Monday, December 13, at 4:00 p.m. ET, will reveal outcomes from this tri-therapy use in FLT3-mutated subjects unsuitable for intensive chemotherapy. The combination appears “particularly encouraging in the frontline setting,” according to the authors, but you’ll need to attend to fully educate your palate on the topic. 

If you missed the session “AML: So Many Options, So Little Time” on Saturday, you can still have your cake (and, you know…) by watching it on-demand via the virtual platform. Dr. Felicitas Thol, one of the presenters, circled back with us on “new treatment options … beyond 7+3 alone for fit patients with AML.” Dr. Thol recapped her talk on “indications for midostaurin, CPX-351, gemtuzumab ozogamicin, ivosidenib, enasidenib, oral azacitidine, gilteritinib, venetoclax and glasdegib” as well as “the results of clinical trials that led to their approval [and] trials with novel combinations,” ultimately predicting how these might “potentially change the treatment landscape.” Finally, bringing truly unique fare to the table, Dr. Hannah R. Abrams presented “Code Status Transitions in Patients with High-Risk Acute Myeloid Leukemia” on Saturday. “Transitions in goals of care can be rapid in AML because treatment is so intense and clinical decompensation can be so sudden,” Dr. Abrams explained. “Patients and their families have often not had time to talk to each other or to their oncologist about what they want at the end of life, and this can cause immense distress.” Accordingly, her work demonstrated that “for many patients, the time between code status changes and death is remarkably short,” she added. Her greatest takeaway? “How important it is to normalize early pre-emptive discussions of code status.” You can also watch this session on-demand via the virtual platform. 

One of our central focuses this year, from a more personal standpoint, will be honoring Dr. Elihu H. Estey — a legend in the field of leukemia, eminent critical thinker, and dignified scholar who passed away suddenly in October. Dr. Estey was a man of great humanity, a mentor, and a global leader in hematology, who inarguably changed practice – and changed lives. An inspiring tribute is provided by Dr. Roland B. Walter in a recent issue of Leukemia.  

And so, as the aforementioned acute myeloid leukemia sessions represent mere morsels of the wide assortment of information we have on our plates at this year’s meeting, we encourage you to nestle in at your table, open wide, and sink your teeth into this feast of food for thought – just don’t forget to wear your stretchy pants and leave room for dessert! 

Dr. Szuber indicated no relevant conflicts of interest.  

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