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Precision Medicine in Myeloid Malignancies: Hype or Hope?

  • Health Economics (N Khera, Section Editor)
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Abstract 

Purpose of Review

We review how understanding the fitness and comorbidity burden of patients, and molecular landscape of underlying acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) at the time of diagnosis is now integral to treatment.

Recent Findings

The upfront identification of patients’ fitness and molecular profile facilitates selection of targeted and novel agents, enables risk stratification, allows consideration of allogeneic hematopoietic cell transplantation in high-risk patients, and provides treatment selection for older (age ≥ 75) or otherwise unfit patients who may not tolerate conventional treatment. The use of measurable residual disease (MRD) assessment improves outcome prediction and can also guide therapeutic strategies such as chemotherapy maintenance and transplant. In recent years, several novel drugs have received FDA approval for treating patients with AML with or without specific mutations. A doublet and triplet combination of molecular targeted and other novel treatments have resulted in high response rates in early trials. Following the initial success in AML, novel drugs are undergoing clinical trials in MDS.

Summary

Unprecedented advances have been made in precision medicine approaches in AML and MDS. However, lack of durable responses and long-term disease control in many patients still present significant challenges, which can only be met, to some extent, with innovative combination strategies throughout the course of treatment from induction to consolidation and maintenance.

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Authors and Affiliations

  1. Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE, USA

    Shristi Upadhyay Banskota

  2. Division of Hematology and Oncology, Franciscan Health, Indianapolis, IN, USA

    Nabin Khanal

  3. Division of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA

    Rosalyn I. Marar

  4. Division of Hematology and Oncology, Blood and Marrow Transplantation Department of Internal Medicine, University of Iowa Health Care, Iowa City, IA, USA

    Prajwal Dhakal

  5. Division of Hematology and Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198-6840, USA

    Vijaya Raj Bhatt

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  1. Shristi Upadhyay Banskota
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  2. Nabin Khanal
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Correspondence to Vijaya Raj Bhatt.

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Conflict of Interest

VRB reports participating in Safety Monitoring Committee for Protagonist, and receiving consulting fees from Genentech, Incyte, Servier Pharmaceuticals LLC, and AbbVie; research funding (institutional) from AbbVie, Pfizer, Incyte, Jazz, and National Marrow Donor Program; and drug support (institutional) from Oncoceutics for a trial. All other authors declare that they have no conflict of interest.

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Upadhyay Banskota, S., Khanal, N., Marar, R.I. et al. Precision Medicine in Myeloid Malignancies: Hype or Hope?. Curr Hematol Malig Rep 17, 217–227 (2022). https://doi.org/10.1007/s11899-022-00674-4

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