Genetic Profiling: Identifying High-Risk and Low-Risk AML Patients

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Topics include: Treatment | General , Treatment and Understanding

Can doctors determine a patient’s risk for progression through genetic profiling? Acute myeloid leukemia (AML) expert Dr. Ross Levine of Memorial Sloan Kettering Cancer Center joined Patient Power to share the latest AML research. Dr. Levine discusses the role molecular characterization plays in prevention, familial predispositions, disease development and the approach to treatment. Watch now to find out what AML patients can learn about their condition from their genetic profile. 

This is a Patient Empowerment Network program produced by Patient Power, in partnership with The Leukemia & Lymphoma Society (LLS). We thank Astellas, Celgene Corporation, Novartis, Pfizer and Seattle Genetics for their support.

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

I’ve got to ask you, for either of you, is there any hereditary family connection? So should Rick worry about he’s third?

Frederick Ross:

The Fourth.

Andrew Schorr:           

You’ve got Rick Ross, IV, and then, maybe someday there will be the fifth. But I mean, do you have to worry about it in your family? Or if there was leukemia in your family, does that have anything to do with you developing AML?      

Dr. Levine:       

So a very small fraction of patients who have AML have inheritable component. And, usually, it’s quite apparent, meaning that when a patient comes in, they’ve had multiple other family members. We can map the gene. And we are very careful about taking that history now, because there are tests we can run. So in those rare circumstances where multiple family members have been affected by blood cancers, we have an approach that we and any expert would take. And then, we would do testing.

That’s the minority. I think the majority of leukemia, building on something that Gwen said, that we’re now starting to understand is that everybody has a few stem cells that are a little bit altered compared to the others. They’re there in everybody. And probably, once you hit the age of 60, it’s in most people. And by 70 or 80, it’s in all people. So the question you have to ask yourself is not why do you get cells that start to go awry, but why, in most people, do they not go further awry and in others they do?

So we had done some work recently that we reported out wherein people that have had other cancers like breast cancer or thyroid cancer, we looked at that, and we had a great opportunity, because we had done a lot of sequencing of the molecular characterization of the tumor, the breast cancer, the thyroid cancer. And we used the blood as our comparator. So then we can do the opposite and look at the blood of these people. And 25 percent of all cancer patients that we see at Sloan Kettering have leukemia-associated mutations in their blood. The good news is that most of them don’t develop leukemia.

But there are two critical things we learned. The first is that we can start to figure out, based on the different molecular profiling, who are the high-risk people. The people that are at risk at 25- to 30-fold everybody else. And so, our approach at Sloan Kettering will be to begin doing clinics where we take care of these people who are at high risk.

And we watch them before they get into trouble. The other thing is we’ve begun to do, as Gwen said, there’s always been this question of what did I get exposed to? How did this happen to me? So in our early studies, what we found is the two strongest predictors for people that have other cancers are smoking and radiation exposure, even more than having gotten chemotherapy. And I will tell you, it was a surprise. No one ever thinks of leukemia and smoking. We think of lung cancer and other tumors—very strong signature. So I actually think all of the things that your primary care doctor tells you to do to take care of yourself are going to turn out to be really important in keeping those clones from misbehaving.

I think anything that causes inflammation, obesity, smoking, all of these things, these lifestyle changes, we’re going to find out that the reason they’re associated more and more with cancer is because they’re the thing that allows these cells to now, they change the situation where you go from being in a—imagine you’re in a field.

And you’re a farmer. And the soil is wonderful. Imagine that only a few of those seeds are altered or awry. But everybody can grow. Now, imagine the water is gone, and you’re now in a desert. Who is going to survive when you, all of a sudden, make everything more challenging? The normal cells or the ones that have a little bit of an advantage? So I think all of the things we do in our lifestyle that allows these cells a situation where other cells maybe aren’t going to survive, when we challenge ourselves. And so, I think that’s a direction.

And what’s exciting about that is that I think scientifically, and the LLS has seen this as have many other foundations and funding agencies, the field of people that study cancer like me, and the people who study prevention, have never worked together. And, in fact, the prevention field has not made much progress. There are not many things you can do to prevent cancer, except for screening. But I think we’re going to enter a new era where we’re going to have drugs and lifestyle alterations.

And they’re going to be tailored on the molecular risk of that person. So even that would be tailored. So I think, early days, a lot coming. And the reason I bring all of this up is that patients ask me, every time I do an event like this, every time I’m in the room with somebody newly diagnosed, I’m sure you asked doctors, why me. Why did I get this? And maybe this is the first time we’ll be able to not only say we’re getting to know why you, because we know it’s usually not in your family. But we’ll begin to know why you and maybe why next time it wouldn’t have been you, or it won’t be you. And I think we have some exciting ideas.

Andrew Schorr:           

And also, as you understand me, going back to something you said, it will also be do you have a therapy or a trial that lines up with that?

Dr. Levine:       

That’s right. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on April 10, 2018