Acute myeloid leukemia (AML) treatments have evolved significantly in recent years, with the introduction of targeted therapies and novel agents offering improved outcomes. However, these advancements come with the challenge of managing a range of adverse events (AEs). Proper assessment, monitoring, and management of these AEs are essential to optimizing treatment efficacy and patient safety. Below, we outline common AEs associated with AML therapies, provide guidance for monitoring, and detail best practices for managing AEs.

Common AEs in AML Treatments^1-8

AEs in AML therapy can vary depending on the specific agent used, but several are common across treatments:

Agent-Specific AEs and Management

While some AEs are common, others require specialized attention based on the agent being used. The table below outlines agent-specific AEs and recommended management strategies as per the 2022 European LeukemiaNet (ELN) guidelines.¹

ECG, electrocardiogram; PRES, posterior reversible encephalopathy syndrome; SOS, sinusoidal obstructive syndrome; TLS, tumor lysis syndrome; VOD, veno-occlusive disease.

Best Practices for AE Monitoring and Assessment

Effective management of AEs is crucial to maintaining therapy adherence and maximizing therapeutic outcomes. Here are the best practices for AE monitoring:

1. Regular Laboratory Monitoring:
   Frequent blood tests are necessary to monitor hematologic parameters, liver enzymes, and electrolyte levels, especially for agents associated with myelosuppression (CPX-351, venetoclax) and hepatic toxicity (gilteritinib, enasidenib).^2-5
2. ECG Monitoring:
   For patients on drugs like midostaurin, gilteritinib, and glasdegib, regular ECGs are needed to monitor the QT interval and prevent serious cardiac complications.^3,6-7
3. Infection Prevention:
   Given the high risk of neutropenia, especially with venetoclax and CPX-351, preventive anti-infective measures (eg, antibacterial, antifungal, and antiviral prophylaxis) are recommended, along with the possible use of growth factors to boost white blood cell recovery.^2,5
4. Prophylactic Measures for TLS:
   In patients with high tumor burden, particularly those receiving venetoclax, aggressive hydration, uric acid-lowering agents, and electrolyte monitoring are vital to prevent TLS.²

AEs are a critical aspect of managing AML therapy, with each novel agent presenting unique challenges. Regular monitoring, timely interventions, and tailored management strategies are key to minimizing the impact of AEs and ensuring successful outcomes. By following established guidelines and best practices, clinicians can help patients with AML navigate treatment with fewer complications, optimizing their overall prognosis.

References

1. Döhner H, Wei AH, Appelbaum FR, et al. Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN. Blood. 2022;140(12):1345-1377. doi:10.1182/blood.2022016867
2. Venclexta (venetoclax) [prescribing information]. North Chicago, IL; AbbVie Inc; 2024.
3. Xospata (gilteritinib) [prescribing information]. Northbrook, IL; Astellas Pharma US Inc; 2022.
4. Idhifa (enasidenib) [prescribing information]. Princeton, NJ;  Bristol-Myers Squibb Company; 2023.
5. Vyxeos (daunorubicin and cytarabine) [prescribing information]. Palo Alto, CA; Jazz Pharmaceuticals Inc; 2022.
6. Rydapt (midostaurin) [prescribing information]. East Hanover, NJ; Novartis Pharmaceuticals Corporation; 2023.
7. Daurismo (glasdegib) [prescribing information]. New York, NY; Pfizer Inc; 2023.
8. Cancer Research UK. Short term side effects of treatment for acute myeloid leukaemia (AML). Accessed December 12, 2024. https://www.cancerresearchuk.org/about-cancer/acute-myeloid-leukaemia-aml/treating-aml/side-effects-aml/about-acute-myeloid-leukaemia-treatment-side-effects