Outpatient Combination Therapy in Patients With Newly Diagnosed AML

At the 2022 Lymphoma, Leukemia & Myeloma Congress in New York, Keith Pratz, MD, University of Pennsylvania, Philadelphia, PA provides insights into navigating outpatient combination therapy in patients with newly diagnosed acute myeloid leukemia (AML). 

Transcript:

Hello, my name is Keith Pratz and I'm from the University of Pennsylvania. I'm here at the Lymphoma, Leukemia, and Myeloma Congress in New York City. I gave a presentation today on outpatient management of acute myeloid leukemia (AML), which is becoming a more common issue. We have some very effective therapies that can be given in the outpatient setting. My discussion today revolved around some of the things that we do to allow patients to receive therapy for acute myeloid leukemia in the outpatient setting, and specifically the discussion around how to best manage patients given the standard therapy for acute myeloid leukemia, venetoclax and azacytidine.

We have realized over the past 5 years that this is a treatment that can be offered to patients who are healthy enough to be outside the hospital. There are several things that we’ve established that are important to safely do that in the outpatient setting. Folks given this treatment should be medically stable and free of infection and symptoms related to their disease. In patients who are older, if they don’t have a high white blood cell count, have good kidney function and are free of infections, we can manage this disease initially in the outpatient setting. At our institution, we’ve been able to treat about half of our patients with this treatment in the outpatient setting. In the past, almost everyone with myeloid leukemia had been hospitalized to get that treatment. Clearly, we are moving in a direction of an improved quality of life for patients [who are being] given this treatment.

Some of the things we've also learned in this development of the treatment is that it's important to prophylax against infectious complications in patients. We give, standardly, drugs to prevent zoster, such as acyclovir, and levofloxacin to prevent bacterial infections. This is an important piece to be given for the whole month of initial therapy, and often the second month, as patients given azacitidine and venetoclax commonly have neutropenia in the first month and the second month of treatment.

For patients given this treatment, it is critically important to get a disease assessment at the end of the first cycle of treatment. A bone marrow biopsy is the way we do that, generally around day 21 of treatment. Those patients who have cleared their leukemia from their bone marrow, we'll stop their therapy, give them growth factors in the form of [granulocyte colony-stimulating factor] (GCSF) to stimulate blood count recovery. We have found that to be associated with an improvement in the ability to maintain patients on treatment. It appears to be an improvement in the overall survival of patients given this treatment over those that don't get GCSF treatment as part of their care.

[There are] some things [to note] in the disease assessments that we can learn that establish how well treatments are going to work over time. We recently published some information about measurable residual disease assessments in this disease, showing that those who have a clearance of their [minimal residual disease] (MRD) have an improved outcome. There is some interesting data that has been recently published from a group in Australia that says that there are a group of people who are MRD negative at 1 year that perhaps can stop the treatment, which is an intriguing idea, and hopefully a future area we'll investigate further to understand how best to apply that to patients given this treatment.

In summary, I think what we know about this outpatient management now is [that] there's a safe regimen that can be administered with appropriate guidance to get patients through into remission and to continue treatment with individualized care. We highlighted a lot of that care in our talk today.

Source:

Pratz, K. Navigating Outpatient Combination Therapy in Newly Diagnosed AML. Presented at Lymphoma, Leukemia & Myeloma Congress; October 18-22, 2022. New York, NY.