Dr Patrick Reville: How Patients With MDS, MPAL Responded to Venetoclax With CLIA

Patrick Reville, MD, MPH, instructor, Department of Leukemia, MD Anderson Cancer Center, elaborates on how certain patients responded to the updated treatment regimen.

Although patients with both high-risk myelodysplastic syndrome (MDS) and mixed phenotype acute leukemia (MPAL) made up a small portion of the study, this group's composite complete response rate was 100%. Patrick Reville, MD, MPH, instructor, Department of Leukemia, MD Anderson Cancer Center, explains the takeaways from this result.


What can we learn from the patients with MDS and MPAL in this study?

I think that there's a lot of push in the MDS/AML [acute myeloid leukemia] field to better treat the high-risk MDS patients. There's a series of new diagnostic classification schemes that have come out in the last year that suggests that some of these MDS patients that are in this high-risk category are really prone to progressing to acute myeloid leukemia. Our approach has been that, for those patients, a treatment with an AML-like regimen seems to be really useful for those patients.

The biggest takeaway from those smaller subsets is that, one, the patients with high-risk MDS—and really the patients that we're talking about there are the ones that we're really concerned are going to progress to an aggressive acute myeloid leukemia quickly from that slightly more indolent, high-risk MBS phase—those patients seem to benefit from treatment with an AML-like regimen upfront, and that's why we included them in this study.

Similarly, mixed phenotype acute leukemia is something that isn't very well categorized in terms of how to treat it. It's more rare than either AML or MDS by itself. We still struggle sometimes with what's the best way to treat these patients, so we felt strongly about including those patients in this clinical trial to learn better about how we can treat them more effectively.

The other caveat to mention is mixed phenotype acute leukemia is really broken down into those that have more of a lymphoid predominant or more of a myeloid predominant. For these patients, these have more of a myeloid predominance leukemia clone, so for those patients, I think our data would suggest this is a really effective regimen for those people.

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