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ASH regularly produces educational webinars, video series, and podcasts that feature presentations by experts in the field, cover current information on how to best diagnose and care for patients, and topical discussion on issues relevant to hematology. This content is free to stream on ASH On Demand.


Description

This webinar has been produced in conjunction with The Leukemia & Lymphoma Society.

Participants can now claim CME and CE credit for this webinar event. View details and claim CME/CE credit below.

Acute myeloid leukemia (AML) is the most common acute leukemia in the United States and worldwide, but despite advances in the treatment of other blood cancers, the standard of care for most AML patients has changed very little in 40 years. The American Society of Hematology (ASH) has teamed up with The Leukemia & Lymphoma Society (LLS) through its “Beat AML” initiative to educate hematologists and other health care professionals about the importance of using advanced genomic technology to understand the genetic mutations in AML and identify targeted therapies to inhibit these mutations and more effectively treat the cancer. Tune in to this webinar on current and novel approaches to treating AML, featuring Ross Levine, MD, and Bernadette Cuello, NP, and learn more about LLS’s precision medicine Beat AML Master Trial, designed to test novel targeted therapies and change the treatment paradigm for patients diagnosed with AML.


To help you complete the post-test for CE/CME credit, please read the Additional Resources below. See the “Claim CE/CME" tab for further instructions.

Treating AML: Current and Novel Approaches

Acute Myeloid Leukemia1,2,3,4
There are 40,255 people living with Acute Myeloid Leukemia (AML) in the United States, with an estimated 19,950 new cases that will be diagnosed in 2016. According to SEER, the number of new cases of acute myeloid leukemia was 4.1 per 100,000 men and women per year. The number of deaths was 2.8 per 100,000 men and women per year. These rates are age-adjusted and based on 2009-2013 cases and deaths.

AML, a cancer of the bone marrow and the blood, progresses rapidly without treatment, and can be difficult to treat. AML is characterized by a clonal (starting from a single malignant cell) proliferation of myeloid precursors with a reduced capacity to differentiate into the different blood cells. As a result, there is an accumulation of immature leukemic cells, called “blasts.” These are found in the bone marrow, peripheral blood, and occasionally in other tissues, with a variable reduction in the numbers of normal red blood cells, platelets, and mature granulocytes. AML that transforms from a myelodysplastic syndrome (MDS) is still considered to be AML. In disease that transforms from other myeloproliferative or myelodysplastic/myeloproliferative neoplasms, it helps to know if the acute process arose from an underlying chronic disease. Leukemia that arises from an underlying chronic disease or from previous therapy is less likely to respond to current anticancer treatments and, therefore, it is less likely to be cured.

Signs and Symptoms of AML2,3,4
General signs and symptoms of the early stages of AML may mimic those of the flu or other common diseases. Signs and symptoms may vary.

Signs and symptoms of acute myeloid leukemia include

  • fever
  • bone pain
  • lethargy and fatigue
  • shortness of breath
  • pale skin
  • frequent infections
  • easy bruising
  • unusual bleeding, such as frequent nosebleeds and bleeding from the gums.

Diagnosis and Classification of AML2,3,4
There are several AML subtypes. The subtypes are based on the World Health Organization (WHO) classification. Blood and marrow tests are used to diagnose AML and the AML subtypes. A pathology report, cytogenetic analysis report and a molecular genetics report all provide information that is important for making a diagnosis and in the treatment planning process. Cytogenetic category classification is one of the most important ways to classify AML. A lab test called a “polymerase chain reaction (PCR)” may be done to see if there are certain changes in structure or function in genes. AML cells may have features of red cells, platelets, or white blood cells in addition to myeloblasts (immature white blood cells that form in the bone marrow) or promyelocytes (granulocyte precursors, develop from myeloblasts).

AML Treatment3,4,5
Despite advances in treating other blood cancers, the standard of care for AML patients has not changed in many years. AML requires immediate and aggressive treatment; however, most patients treated with conventional therapies will have a relapse of their disease. The initial goal of treatment usually is to get the patient into remission. The long-term goal is to cure the disease.

Intensive chemotherapy is required to achieve a complete remission. At least two drugs are combined to treat patients initially. Most AML patients are treated with a combination of drugs often called “7 plus 3,” which includes cytarabine which is given for seven to 10 days and an anthracycline, which is usually started at the same time, but given in the first three days of treatment.

More treatment is needed once a remission is achieved to help prevent a relapse. Postremission treatment may consist of chemotherapy, stem-cell transplantation or low-dose maintenance chemotherapy or a combination of the three.

Some patients are treated in clinical trials with new drugs and new drug combinations or new approaches to stem cell transplantation.

A number of factors affect the choice and outcome of treatment, including:

  • AML subtype
  • The results of cytogenetic analysis
  • Whether the patient has received chemotherapy in the past to treat another type of cancer
  • Whether the patient had myelodysplastic syndrome (MDS) or another blood cancer
  • Whether the AML is in the central nervous system
  • Whether the AML has not responded to treatment or has relapsed
  • The presence of systemic infection at diagnosis
  • The patient’s age and general health.

Treatment of Relapsed or Refractory Disease3,4,5
Patients whose AML has relapsed following first-line therapy usually receive additional different chemotherapy followed by allogeneic stem-cell transplantation (if, based on their health and age, they are a good fit for this treatment). Some patients receive other investigational therapies.

Treatment recommendations are based on the age and health of the patient. Age alone is not a contraindication to treatment for older AML patients. Physically fit patients in their 70s and 80s can achieve remission.

Treatment Side Effects3,4
Some of the side effects AML patients may experience from treatment are temporary and subside once the body adjusts to therapy or when therapy is complete. During the course of therapy and after therapy has completed, healthy new cells begin to grow and develop. Severe side effects are treated on an inpatient basis.

AML decreases the production of normal blood cells. In addition, chemotherapy is toxic to both normal blood cells and AML cells. The normal blood cells are eliminated from the marrow along with AML cells.

For the patient, this may result in a severe deficit of the

  • red blood cells (anemia)
  • platelets (thrombocytopenia)
  • white blood cells called “neutrophils” and “monocytes” (neutropenia and monocytopenia).

Transfusion of red blood cells and platelets is almost always needed for several weeks following treatment. After that, the blood cell counts usually return toward normal reference ranges.

Infection3,4
During treatment for AML, the deficiency of neutrophils and monocytes (types of white cells) can lead to infection from bacteria and fungi normally present in the environment, on the skin and in the nose, mouth or colon. The risk of infection may be increased because chemotherapy damages the lining of the mouth and intestines, making it easier for bacteria to enter the blood. When the white blood cell count is low and the risk of infection is increased, antibiotics are given to either prevent or treat infection. Transfusion of white blood cells is not generally used for patients who have a low neutrophil count, but transfusion can be used in patients who have a high fever, infection that is unresponsive to antibiotics, blood fungal infections, or septic shock.

Growth factors may be given to adult patients to stimulate the marrow to make new white blood cells. In children, they are used only in special circumstances.

Since many patients are immunocompromised and prone to infection due to disease and/or treatment, the medical staff, caregivers, and loved ones, need to practice frequent and vigorous hand washing and take other precautions to avoid exposing patients to bacteria, viruses and other infection-causing agents.

Patients at home should not delay in seeking medical attention if any signs of infection develop. A rise in temperature to 101°F or higher, or the onset of chills, may be the only sign of infection in a patient with a very low white blood cell count. Other signs of infection may include persistent coughing; tenderness at a site prone to infection, such as the area surrounding the anus or the facial sinuses; sore throat; pain on urination; or frequent loose stools. Patients should not take acetaminophen or any other drugs unless the medication has been approved by their physician.

Chemotherapy Side Effects3,4
Chemotherapy affects tissues that normally have a high rate of cell turnover. Thus, the lining of the mouth, the lining of the intestines, the skin and the hair follicles may be affected. Common side effects are listed in the Overview of Blood Cancer Treatment Section.

As a result of a very high white blood cell count, some AML patients may have a buildup of uric acid (a chemical normally found inside the cell) in their bloodstream. The uric acid is then excreted in the urine. In addition, the use of chemotherapy may also increase uric acid values. If many cells are killed simultaneously by therapy, the amount of uric acid in the urine can be so high that kidney stones can form. This may seriously interfere with the flow of urine. Drugs such as allopurinol (Zyloprim®) or rasburicase (Elitek®) can be given to minimize the buildup of uric acid in the blood.

Peripheral neuropathy (PN), a potential side effect of several cancer therapies, is manifested as weakness, numbness and pain, usually in the hands and feet.

Please visit The Leukemia & Lymphoma Society’s Acute Myeloid Leukemia webpage for additional reading: www.LLS.org/AML

  1. www.lls.org/resource-center/download-or-order-free-publications
  2. www.lls.org/leukemia
  3. www.lls.org/leukemia/acute-myeloid-leukemia?src1=20032&src2
  4. www.nccn.org/professionals/physician_gls/f_guidelines_nojava.asp
  5. http://www.lls.org/beat-aml

How to Claim CE/CME Credit

Date of release - June 2017
Date of expiration - Online access expiration and last date for learners to claim CE/CME credit for this webinar: May 31, 2018

Approval for nurses has been obtained by the National Office of The Leukemia & Lymphoma Society under Provider Number CEP 5832 to award 1.0 continuing education contact hour through the California Board of Registered Nursing.

The Leukemia & Lymphoma Society designates this enduring material for a maximum of 1 Continuing Education Credit.

The American Society of Hematology is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education to physicians.

The American Society of Hematology designates this enduring material for a maximum of 1 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Non-physicians may request a certificate of participation.

Claim CE For Nurses
To receive credit and a certificate of completion, participants must read the additional information regarding AML treatment on the Additional Resources tab and complete an evaluation and post-test on the LLS website.

Please visit http://www.cancereducation.com/cancersyspagesnb/a/lls/lls1708/ and enter the validation code provided at the end of the webinar. The evaluation and post-test will be available on the LLS website through May 31, 2018.

Claim CME for Physicians and other Non-Physicians
To receive CME credit or a participation certificate, participants must also read the additional information regarding AML treatment on the Additional Resources tab and complete an evaluation and post-test on the ASH Academy.

To register for the free CME Evaluation and Post-Test, visit http://hematology.org/TreatingAMLCME and sign in to your ASH account. If you do not have a web account with ASH you may create one prior to registering for the CME Evaluation Module. The Module will be available on the ASH Academy website (www.ashacademy.org) through May 31, 2018. Certificates may be printed directly from the ASH Academy upon completion of the evaluation and post-test.

Speakers

  • Ross Levine, MD, Physician Scientist; Member of the Human Oncology and Pathology Program; Attending Physician on the Leukemia Service, Department of Medicine; The Laurence Joseph Dineen Chair in Leukemia Research, Director of the Memorial Sloan Kettering Center for Hematologic Malignancies
  • Bernadette Cuello, NP, Outpatient Leukemia Service, Memorial Sloan Kettering Cancer Center

Description

Thinking of attending the 2017 ASH Meeting on Hematologic Malignancies? Join us for the first in a series of special webinar previews of the 2017 meeting. Listen to speakers from the meeting as they preview their presentations, then stay for a special Q&A session to talk directly to meeting organizers and find out why you should join us in Chicago in September 2017!
The ASH Meeting on Hematologic Malignancies includes five core malignant hematology themes: leukemia, lymphoma, myelodysplastic syndromes, myeloproliferative neoplasm, and myeloma. This Focus on Myeloma webinar will feature a discussion with three clinicians in the area of Myeloma regarding how clinical practice has evolved in recent years, as well as discussion of important conclusions from the previous year’s meeting. The doctors will also discuss what to expect in the coming year, with emphasis on how “How I Treat” is a different approach than the classic format of educational and or scientific sessions.
The webinar will include a special Q&A session with meeting organizers for participants to chat about anything related to the meeting or registration.
The next ASH Meeting on Hematologic Malignancies will be held in Chicago, IL, September 8-9, 2017. The program’s “How I Treat” presentations showcase speakers’ evidence-based treatment approaches, identify cutting-edge scientific data that can be translated into new strategies for diagnosis and treatment, and address what to do in cases where there is no data. This meeting is a unique opportunity to join colleagues and top experts in treatment of hematologic malignancies in an intimate, smaller-meeting setting and discuss the latest drug developments and most relevant research findings advancing patient care today. Visit www.hematology.org/malignancies for information related to next year’s meeting!

Speakers

  • Ken Anderson, MD, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute
  • Noopur Raje, MD, Multiple Myeloma Center, Massachusetts General Hospital
  • S. Vincent Rajkumar, MD, Edward W. and Betty Knight Scripps Professor of Medicine, Mayo Clinic

Description

Click here to view the Powerpoint
 
On October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) released its final rule (regulation) outlining the new payment system for Medicare clinicians, implementing the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) payment provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This webinar provides an overview of the final rule and its impact on hematology, as well as outlines the compliance implications for ASH’s clinical practice members.

Speakers

  • Joseph Alvarnas, MD, City of Hope National Medical Center, Duarte, CA
  • Erika Miller, JD, Cavarocchi – Ruscio – Dennis Associates, LLC, Washington, DC

Description

The ASH Meeting on Hematologic Malignancies includes five core malignant hematology themes: leukemia, lymphoma, myelodysplastic syndromes, myeloproliferative neoplasm, and myeloma. This Focus on Lymphoma webinar features a discussion with two clinicians in the area of Lymphoma regarding how clinical practice has evolved in recent years, as well as discussion of important conclusions from the previous year’s meeting. The doctors also discuss what to expect in the coming year, with emphasis on how "How I Treat" is a different approach than the classic format of educational and or scientific sessions.
 
The next ASH Meeting on Hematologic Malignancies will be held in Chicago, IL, September 8-9, 2017. The program’s “How I Treat” presentations showcase speakers’ evidence-based treatment approaches, identify cutting-edge scientific data that can be translated into new strategies for diagnosis and treatment, and address what to do in cases where there is no data. This meeting is a unique opportunity to join colleagues and top experts in treatment of hematologic malignancies in an intimate, smaller-meeting setting and discuss the latest drug developments and most relevant research findings advancing patient care today. Visit www.hematology.org/malignancies for information related to next year’s meeting!

Speakers

  • Joseph Connors, MD, BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC
  • Jonathan W. Friedberg, MD, MMSc, Wilmot Cancer Institute, University of Rochester, Rochester, NY

Description

"Still haven't registered for the 2016 ASH Meeting on Hematologic Malignancies? Join us for this special webinar preview of what will be presented next month! Listen to three program speakers as they give you an exclusive sneak-peek into what they will present at the meeting. Then participate in a special Q&A session to find out why you should join us in Chicago in September!
 
This webinar will feature a special preview of presentations by three distinguished presenters from the upcoming meeting, structured in the \"How I Treat\" format to best convey how you can immediately apply evidenced-based treatment approaches to practice:
  • Dr. David Steensma: How I treat lower-risk myelodysplastic syndromes (MDS)
  • Dr. Ruben Mesa: How I Treat Myelofibrosis Patients Who Have Failed Ruxolitinib
  • Dr. John P. Leonard: How I Treat Diffuse Large B-Cell and Mediastinal Large Cell Lymphomas
The ASH Meeting on Hematologic Malignancies, will be held in Chicago, IL, September 16-17. This meeting is a unique opportunity to join colleagues and top experts in treatment of hematologic malignancies in an intimate, smaller-meeting setting and discuss the latest drug developments and most relevant research findings advancing patient care today. Visit www.hematology.org/malignancies to review speaker line-up and program schedule and to register.

Speakers

  • Dr. David Steensma
  • Dr. Ruben Mesa
  • Dr. John P. Leonard

Description

This webinar discusses the FDA accelerated approval of nivolumab for the treatment of patients with classical Hodgkin lymphoma (cHL) that has relapsed or progressed after autologous hematopoietic stem cell transplantation (HSCT) and post-transplantation brentuximab vedotin. The approval was based on two single-arm, multicenter trials of nivolumab in adults with relapsed or refractory cHL. The trials enrolled patients regardless of PD-L1 expression status on Reed-Sternberg cells. The primary efficacy endpoint was objective response rate (ORR) as determined by an independent radiographic review committee. Additional outcome measures included duration of response (DOR).

Speakers

  • Wyndham Wilson, MD, PhD, Center for Cancer Research, National Cancer Institute, Bethesda, MD
  • Yvette L. Kasamon, MD, Division of Hematology Products, Office of Hematology and Oncology Products, U.S. Food and Drug Administration, Silver Spring, MD
  • Stephen Ansell, MD, PhD, Professor of Medicine, Chair, Lymphoma Group, Mayo Clinic, Rochester, MN

Description

This webinar discusses the FDA's accelerated approval of venetoclax for the treatment of people with chronic lymphocytic leukemia (CLL) who have received at least one prior therapy, including those with 17p deletion. Venetoclax is a small molecule inhibitor of the BCL-2 protein and was granted Breakthrough Therapy Designation by the FDA in April 2015 for the treatment of people with previously treated (relapsed or refractory) CLL with 17p deletion.

Speakers

  • Grzegorz S. Nowakowski, MO, Division of Hematology, Mayo Clinic, Rochester, MN
  • Lori Ehrlich, MD, Division of Hematology Products, Office of Hematology and Oncology Products, U.S. Food and Drug Administration, Silver Spring, MD
  • Richard R. Furman, MD, Department of Hematology/Oncology, Weill Cornell Medical College, New York, NY

Description

This webinar will discuss the FDA approval of Ixazomib in combination with two other therapies to treat people with multiple myeloma (a form of blood cancer found in the bone marrow) who have received at least one prior therapy. Ixazomib is the first oral proteasome inhibitor and is approved in combination with lenalidomide and dexamethasone (a type of corticosteroid).

Speakers

  • David Steensma, MD, Dana-Farber Cancer Institute, Division of Hematological Malignancies, Boston, MA
  • Alexandria Schwarsin, MD, Medical Officer, U.S. Food and Drug Administration, Silver Spring, MD
  • S. Vincent Rajkumar, MD, Edward W. and Betty Knight Scripps Professor of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN

Description

This webinar discusses the FDA's accelerated approval of daratumumab to treat patients with multiple myeloma who have received at least three prior treatments. Daratumumab is the first monoclonal antibody approved for treating multiple myeloma.

Speakers

  • Mikkael Sekeres, MD, Director, Leukemia Program, Professor of Medicine, Cleveland Clinic, Cleveland, OH
  • Nicole Gormley, MD, Acting Clinical Team Lead, Scientific Liaison for Multiple Myeloma, Division of Hematology Products, U.S. Food and Drug Administration, Silver Spring, MD
  • Paul G. Richardson, MD, RJ Corman Professor of Medicine, Harvard Medical School, Clinical Program Leader, Director of Clinical Research, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA

Description

This webinar recording discusses the FDA approval of von Willebrand factor (Recombinant), for use in adults 18 years of age and older who have von Willebrand disease (VWD). This is the first FDA-approved recombinant von Willebrand factor for the on-demand (as needed) treatment and control of bleeding episodes in adults diagnosed with VWD.

Speakers

  • Paula James, MD, FRCPC, Professor, Department of Medicine, Queen's University, Kingston, Ontario
  • Victor Baum, MD, Division of Hematology Clinical Review, U.S. Food and Drug Administration, Silver Spring, MD; Adjunct Professor of Anesthesiology & Pediatrics, George Washington Univ. School of Medicine
  • Margaret V. Ragni, MD, MPH, Professor of Medicine and Clinical Translational Science, University of Pittsburgh Medical Center, Director, Hemophilia Center of Western PA, Pittsburgh, PA
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