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Löwenberg B, Ossenkoppele GJ, van Putten W, et al. High-dose daunorubicin in older patients with acute myeloid leukemia. N Engl J Med. 2009;361:1235-1248. Abstract
Castaigne S, Pautas C, Terre C, et al. Fractionated doses of gemtuzumab ozogamicin (GO) combined to standard chemotherapy (CT) improve event-free and overall survival in newly-diagnosed de novo AML patients aged 50-70 years old: a prospective randomized phase 3 trial from the Acute Leukemia French Association (ALFA). In: Proceedings from the American Society of Hematology; December 10-13, 2011; San Diego, CA. Abstract 6.
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Sorror ML, Giralt S, Sandmaier BM, et al. Hematopoietic cell transplantation-specific comorbidity index as an outcome predictor for patients with acute myeloid leukemia in first remission: combined FHCRC and MDACC experiences. Blood. 2007;110:4606-4613. Abstract
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Zhu YX, Kortuem KM, Stewart AK. Molecular mechanism of action of immune-modulatory drugs thalidomide, lenalidomide and pomalidomide in multiple myeloma. Leuk Lymphoma. 2013;54:683-687. Abstract
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CME

Acute Myeloid Leukemia and Myelodysplastic Syndromes in Older Patients

Authors: Frederick R. Appelbaum, MD; Stephen J. Forman, MD; Gail J. Roboz, MD; David Steensma, MD; Willis Navarro, MD
CME Released: 5/21/2013; Reviewed and Renewed: 9/23/2014
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 9/23/2015

Target Audience and Goal Statement

This activity is intended for hematologists, oncologists, and other healthcare professionals who treat patients with myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML).

The goal of this activity is to discuss the latest approaches to the treatment of older patients with MDS and AML.

Upon completion of this activity, participants will be able to:

Identify disease- and patient-related factors that predict outcomes of hematopoietic cell transplantation (HCT), new drugs, or combination therapy in older patients with MDS and AML
Explain recent clinical trial results that have influenced the selection of patients for treatment of MDS and AML
Compare the risks and benefits of treatment options and how timing of therapy choices affects outcomes
Describe appropriate candidates for a prospective study on outcomes of HCT in adults 65 years of age and older with MDS

Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Author(s)

Frederick R. Appelbaum, MD

Executive Director, Seattle Cancer Care Alliance; Director, Fred Hutchinson Cancer Research Center; Professor, University of Washington School of Medicine, Seattle, Washington

Disclosures

Disclosure: Frederick R. Appelbam, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Celator Pharmaceuticals, Inc.; Pfizer Inc; Igenica, Inc.; Abbott Laboratories

Dr Appelbaum does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Appelbaum does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Stephen J. Forman, MD

Francis and Kathleen McNamara Distinguished Chair in Hematology and Hematopoietic Cell Transplantation; Clinical Director, Cancer Immunotherapeutics & Tumor Immunology, City of Hope, Duarte, California

Disclosures

Disclosure: Stephen J. Forman, MD, has disclosed no relevant financial relationships.

Dr Forman does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Forman does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Gail J. Roboz, MD

Director, Leukemia Program; Associate Professor of Medicine, Weill Medical College, Cornell University, New York, New York

Disclosures

Disclosure: Gail J. Roboz, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Celgene Corporation

Dr Roboz does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Roboz does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

David Steensma, MD

Associate Professor of Medicine, Harvard Medical School; Adult Leukemia Program, Dana-Farber Cancer Institute; Hematological Oncology Service, Brigham & Women’s Hospital, Boston, Massachusetts

Disclosures

Disclosure: David Steensma, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Genoptix, Inc.; Celgene Corporation; Novartis Pharmaceuticals Corporation; Amgen Inc.

Dr Steensma does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Steensma does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States

Willis Navarro, MD

Vice President, Transplant Medical Services, National Marrow Donor Program®/Be The Match®, Minneapolis, Minnesota

Current position: Vice President of Clinical Research and Development at Atara Biotherapeutics and Associate Clinical Professor of Medicine at the University of California, San Francisco

Disclosures

Disclosure: Willis Navarro, MD, has disclosed no relevant financial relationships.

Dr Navarro does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Navarro does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editor(s)

Charlotte Warren

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Charlotte Warren has disclosed no relevant financial relationships.

Ellyce Hayes

Strategic Marketing Specialist, National Marrow Donor Program®/Be The Match®, Minneapolis, Minnesota

Disclosures

Disclosure: Ellyce Hayes has disclosed no relevant financial relationships.

Alissa Salvato

Medical Education Outreach Specialist, National Marrow Donor Program®/Be The Match®, Minneapolis, Minnesota

Disclosures

Disclosure: Alissa Salvato has disclosed no relevant financial relationships.

Tim Walker

Medical Writer, National Marrow Donor Program®/Be The Match®, Minneapolis, Minnesota

Disclosures

Disclosure: Tim Walker has disclosed no relevant financial relationships.

CME Reviewer(s)

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

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From Medscape Education Oncology

CME

Acute Myeloid Leukemia and Myelodysplastic Syndromes in Older Patients

Authors: Frederick R. Appelbaum, MD; Stephen J. Forman, MD; Gail J. Roboz, MD; David Steensma, MD; Willis Navarro, MDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME Released: 5/21/2013; Reviewed and Renewed: 9/23/2014

Valid for credit through: 9/23/2015

processing....

Abbreviations

AA = aplastic anemia
ALL = acute lymphoblastic leukemia
ALLIANCE trial = Alliance for Clinical Trials in Oncology
AML = acute myeloid leukemia
ASH = American Society of Hematology
ATG = antithymocyte globulin
ATRA = all-trans-retinoic acid
CALGB = Cancer and Leukemia Group B
CBF = core-binding factor
CEBPA = CCAAT/enhancer binding protein-alpha
CIBMTR = Center for International Blood and Marrow Transplant Research
CMML = chronic myelomonocytic leukemia
CR = complete remission
CRBN = cereblon
DA = daunorubicin + cytarabine
DACi = deacetylase activity inhibitor
AGO = daunorubicin + cytarabine + gemtuzumab
DNMT3A = DNA methyltransferase 3A
DNR = daunorubicin
DFS = disease-free survival
ECOG = European Cooperative Oncology Group
EFS = event-free survival
ESA = erythropoiesis-stimulating agent
FDA = US Food and Drug Administration
G-CSF = granulocyte-colony stimulating factor
FHCRC = Fred Hutchinson Cancer Research Center
FLT3 = FMS-like tyrosine kinase 3
GVHD = graft-versus-host disease
HCT = hematopoietic cell transplantation
HCT-CI = hematopoietic cell transplantation comorbidity index
HLA = human leukocyte antigen
HMA = hypomethylating agent
IL-3 = interleukin 3
IMiDs = immunomodulatory derivatives
IPSS = International Prognostic Scoring System
JAK-2 = Janus tyrosine kinase 2
JCO = Journal of Clinical Oncology
LD = low-dose
LDAC = low-dose cytosine arabinoside (Ara-C)
LGL = large granular lymphocyte
MAP kinase = mitogen-activated protein kinase
MCV = mean corpuscular volume
MDA = MD Anderson Cancer Center
MDACC = MD Anderson Cancer Cancer
MDS = myelodysplastic syndromes
MPD = myeloproliferative disease
MRC = Medical Research Council
MRD = minimal residual disease
NCCN = National Comprehensive Cancer Network
NIH = National Institutes of Health
NK cells = natural killer cells
NMDP = National Marrow Donor Program®
ORR = overall response rate
OS = overall survival
PRCA = pure red cell aplasia
RARS = refractory anemia with ring sideroblasts
RBC = red blood cell
RFS = relapse-free survival
RIC = reduced-intensity conditioning (regimen)
SC = supportive care
SWOG = formerly the Southwest Oncology Group
TET2 = Ten-Eleven-Translocation-2
TNFα = tumor necrosis factor alpha
TRM = transplant-related mortality (risk score)
VEGF = vascular endothelial growth factor
WBC = white blood cell count
WHO = World Health Organization
WPSS = WHO classification-based Prognostic Scoring System

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References

Faculty and Disclosures

Author(s)

Frederick R. Appelbaum, MD

Stephen J. Forman, MD

Gail J. Roboz, MD

David Steensma, MD

Willis Navarro, MD

Editor(s)

Charlotte Warren

Ellyce Hayes

Alissa Salvato

Tim Walker

CME Reviewer(s)

Nafeez Zawahir, MD

CME

Acute Myeloid Leukemia and Myelodysplastic Syndromes in Older Patients

Target Audience and Goal Statement

Disclosures

Author(s)

Frederick R. Appelbaum, MD

Stephen J. Forman, MD

Gail J. Roboz, MD

David Steensma, MD

Willis Navarro, MD

Editor(s)

Charlotte Warren

Ellyce Hayes

Alissa Salvato

Tim Walker

CME Reviewer(s)

Nafeez Zawahir, MD

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Acute Myeloid Leukemia and Myelodysplastic Syndromes in Older Patients

Abbreviations