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For instructor materials including Power Points, Answers to Clinical Encounter Questions, please contact userservices@mhprofessional.com.
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Content Update
December 21, 2023
Quizartinib Approved for FLT3 Internal Tandem Duplication Positive Acute Myeloid Leukemia: The kinase inhibitor quizartinib (Vanflyta®) is approved in combination with cytarabine and anthracycline induction and consolidation therapy for patients with newly diagnosed acute myeloid leukemia (AML) that is positive for FLT3 internal tandem duplication (ITD). The combination was evaluated in an open label phase 3 trial, enrolling a total of 539 adult patients comparing the addition of quizartinib or placebo to standard of care (SOC) cytarabine and anthracycline induction and consolidation therapy. The median overall survival was 31.9 months (95% CI 21.0-not reached) for quizartinib versus 15.1 months (13.2-26.2) for placebo (hazard ratio 0.78, 95% CI 0.62-0.98, p=0.032). Common adverse events included febrile neutropenia, hypokalemia, and pneumonia.
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LEARNING OBJECTIVES
Upon completion of the chapter, the reader will be able to:
Identify the risk factors associated with a poor outcome for the acute leukemias.
Explain the importance of minimal residual disease (MRD) and its implication on early bone marrow relapse.
Explain the role of induction, consolidation, and maintenance phases for acute lymphocytic leukemia (ALL).
Define the role of central nervous system preventive therapy for the treatment of acute lymphocytic leukemia.
Identify new treatment options available based on specific biologic targets for the treatment of adult acute leukemias.
Describe the clinical presentation and diagnosis of acute myelogenous leukemia (AML).
Identify underlying considerations that would determine the most appropriate chemotherapeutic regimens for both acute lymphocytic leukemia and acute myelogenous leukemia.
Recognize the treatment complications associated with the therapy for acute leukemias.
Describe the late effects associated with the treatment of long-term survivors of acute leukemias.
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The acute leukemias are hematologic malignancies of bone marrow precursors characterized by excessive production of immature hematopoietic cells. This proliferation of “blast” cells eventually replaces normal bone marrow and leads to the failure of normal hematopoiesis and the appearance in peripheral blood as well as infiltration of other organs. These blast cells proliferate in the marrow and inhibit normal cellular elements, resulting in anemia, neutropenia, and thrombocytopenia. Leukemia also may infiltrate other organs, including the liver, spleen, bone, skin, lymph nodes, testis, and central nervous system (CNS). Virtually anywhere there is blood flow, the potential for extramedullary (outside the bone marrow) leukemia exists.
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Acute leukemias are classified according to their cell of origin. Acute lymphocytic leukemia (ALL) arises from the lymphoid precursors. Acute myelogenous leukemia (AML) arises from the myeloid or megakaryocytic precursors. As a result of clinical trials defining various prognostic (risk) factors that helped guide treatment modifications, the outcomes of acute leukemias, especially pediatric ALL, have improved dramatically over the past several decades.1 Risk-based treatment strategies that consider multiple phenotypic and biological risk factors and attempt to match the aggressiveness of therapy with the presumed risk ...