Wendy Stock, MD, of the University of Chicago, was the formal discussant of these three studies presented at the 2015 ASCO Annual Meeting. Commenting on the first study on acute myeloid leukemia (AML) by Dr. Gerber and colleagues, she said, “This work can improve understanding of the leukemia stem cell and the course of disease. Many investigators are working in this area. Specific mutations lead to preleukemia and additional mutations lead to leukemia.”
“We are hopeful that patients with AML will remain in remission, but many relapse after achievement of ‘remission.’ This is likely because we have only succeeded in returning the leukemic clone to a preleukemic state, which eventually acquires the same or new mutations that will lead to relapse of the disease. The technique described by Dr. Gerber might help us identify what lurks in these residual marrows,” Dr. Stock said.
“Moving forward, AML evolutional heterogeneity is a challenge for risk assessment and development of new effective therapies. Aldehyde dehydrogenase (ALDH) expression in remission may be a method to help identify patients at high risk of relapse,” she added.
Turning to the second study on myelodysplastic syndromes (MDS) by Dr. Daher and colleagues, Dr. Stock commented, “The novel and major finding of this explorative study is that natural killer cell genotype may be associated with MDS risk.”
Dr. Stock added, “This work is interesting and preliminary. We can’t assume the number of KIR genes is associated with prognosis. The findings need to be confirmed in a larger cohort of MDS patients. We need to determine if activating KIRs do provide immune surveillance and protection for the myeloid progenitor cells.”
Finally, Dr. Stock commented on the third study on chronic lymphocytic leukemia (CLL) by Dr. Kutsch and colleagues. “The CLL–IPI [International Prognostic Index] is an important contribution to the field of CLL. This system will help us put a plethora of prognostic factors into perspective,” she said. “The score is easily applicable and can be applied prospectively. Weighted scoring helps clarify the impact,” concluded Dr. Stock. ■
Disclosure: Dr. Stock reported no potential conflicts of interest.