By O. Arakos. New Mexico State University. 2019.
In addition buy 1 mg arimidex free shipping, the risk proﬁles of combining chemotherapy with rituximab in HIV strongly favors the EPOCH regimen purchase discount arimidex line, for which excess toxicity has not been reported purchase arimidex 1mg fast delivery. At a non-germinal center B-cell-like DLBCL patients treated with short- median follow-up of 73 months, the progression-free and overall course (SC)-EPOCH-RR. Only 16% of the cycles administered were associated with fever and neutropenia. This compelling data was reviewed by the NCI Lymphoma Steering subjects treated with the short-course EPOCH-RR (etoposide, Committee, which recommended funding a national multicenter, prednisone, vincristine, cyclophosphamide, doxorubicin - double single-arm phase 2 study aimed at providing a strong level of dose rituximab) regimen had a progression-free and overall survival 3 evidence for this approach. The study is now being conducted and is of 84% and 68%, respectively, at 5 years median follow-up Tumor available to all AMC, Southwest Oncology Group (SWOG), histogenesis was the only characteristic associated with lymphoma- speciﬁc outcome. The progression-free survival at 5 years was 95% Alliance for Clinical Trials in Oncology, and Eastern Cooperative Oncology Group (ECOG) members to enroll BL and cMYC for those with germinal center B-cell-like DLBCL and 44% for non-germinal center B-cell-like DLBCL (Figure 2). Until the outcome of this analysis of 150 patients treated on AIDS Malignancy Consortium study is known, it is highly recommended to refer patients for (AMC) studies of either R-CHOP or EPOCH-R shows the hazard participation in the study. In addition, several small studies have ratios for event-free survival and overall survival favor the shown that regimens such as CODOX-M (cyclophosphamide, EPOCH-R regimen. For ex- ample, if on restaging after 2 cycles, there is a complete response, administering 1 or 2 more cycles is reasonable and supported by The important message here is that BL in the setting of HIV is highly these data. Inferior outcomes are documented using CHOP-like bolus therapy, which until recently was the standard practice in HIV-BL. Why not await those study results before so patterns of care rather than true survival prospects with optimized strongly recommending the EPOCH-R regimen in HIV-DLBCL? Representative HIV BL studies Study Type N Treatment Findings Wang et al34 Retrospective 14 CODOX-M/IVAC and other 2-year EFS 60% (similar to HIV in report) Noy et al20 Prospective 34 R-CODOX-M/IVAC (risk adapted) 87% 1-year OS (median follow-up 9 mo); no TRM Oriol et al35 Prospective 19 LAL3/97 2-year OS 46% (85% if cART sensitive) Cortes et al36 Prospective 13 HyperCVAD Median OS 12 mo (92% CR); 2-year OS 48% Montoto et al23 Retrospective 30 CODOX-M/IVAC 3-year OS 52% (17% toxic death) Dunleavy et al19 Prospective 11 EPOCH-R PFS 100% and OS 90% with median follow-up 73 mo EFSindicatesevent-freesurvival;CR,completeresponse;andOS,overallsurvival. Hematology 2013 385 Plasmablastic and primary effusion lymphoma must be performed. Prompt initiation of treatment for both the HIV Plasmablastic lymphoma (PBL) and primary effusion lymphoma and the brain tumor may improve the prognosis. Our own clinical (PEL) are both oncogenic virus–driven tumors (EBV for PBL and experience is that rituximab and high-dose methotrexate given with HHV-8 for PEL) associated mainly with HIV advanced immune aggressive leucovorin rescue and concomitant cART is very active, depletion. Both of these tumors carry a poor prognosis, although the with some long-term cures. PBL involves multiple anatomical sites rather than mainly the oral cavity, as originally described. It represents 10% of HIV-DLBCL HL with reported median survivals of 4 to 11 months. We administer abbreviated cycles of EPOCH chemo- cases are EBV associated. Therapeutically, HIV-cHL should be therapy and then consider involved-ﬁeld radiotherapy if all of the approached in the same way as HIV-unrelated HL. Regimens such initial disease is conﬁned to one radiation port. Recent data show that HIV status PBL cases are MYC positive, regimens such as EPOCH that can 28 does not inﬂuence outcome in patients with cHL treated with ABVD overcome high tumor proliferation are logical strategies. Because (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy this tumor is EBV driven, we continue cART (modiﬁed to minimize 31 in the cART era. Optimal curative potential rests on adherence to pharmacokinetic interactions) during chemotherapy. Neurotoxicity and undue neutrope- immune escape that appears central to the pathogenesis for this nia should be ﬁrst attributed to cART and the ﬁrst maneuver should tumor, we recommend consideration for investigational allogeneic be to discontinue it to maintain the chemotherapy dose and transplantation for relapse. This is potently highlighted by experience with excess neurotoxicity and subsequent dose reductions of vinblastine when PEL is associated with HHV-8 in 100% of cases and is required to 32 given with ritonavir-based cART. This raises concerns for similar, establish the diagnosis. Outcome is generally poor, although long-term cures are occasion- ally seen. A strategy of draining the effusions while administering Myeloid and lymphoid leukemias therapy is used in our clinic, but sufﬁcient data to recommend this as There are not sufﬁcient data to inform the approach to HIV patients generally effective or increasing the curative potential are not with leukemia. Based on the principles of achieving tumor control available. From a palliative perspective, at least it relieves effusion- while maintaining immune integrity, one can draw useful guidance related symptoms. The chronic leukemias, especially with newer Primary DLBCL of the CNS and developing therapeutics, are treated over the long-term with AIDS-related PCNSL (AR-PCNSL) is truly an opportunistic, tyrosine kinase inhibitors and other targeted agents. Therefore, it is EBV-driven cancer, nearly always restricted to patients with 50 necessary to coadminister cART carefully planned to minimize CD4 cells/mm3. For acute leukemias, suspension of cART Cases seen in the setting of high CD4 cells are unlikely to be may be the best option. If there is to be a prolonged consolidation AR-PCNSL; especially if EBV unrelated, these cases are more and maintenance phase, selection of antiretroviral agents should be likely to be more akin to PCNSL seen in the background population. These are rare situations, and seeking out prominent The main educational point to be emphasized is the necessity to experts for assistance is encouraged. Hematopoietic stem cell abandon the diagnostic approach standardized in the early 1980s. Referral to mosis and, on progression shown by cranial imaging, treatment for investigational studies for this purpose should be prioritized. In the cART era, this is not a medically sound strategy. Because risk of toxoplasmosis is high in these Kaposi sarcoma–associated herpes virus–associated patients and may occur concurrently with PCNSL, treatment for MCD both may sometimes be required. MCD is a neoplastic inﬂammatory condition with no standard therapy yet informed by adequate data. Patients with this condition The presence of EBV in AR-PCNSL and its nuclear medicine are clearly best served by referral to research studies. Rituximab can imaging avidity, thallium-201–based tomography or ﬂuorodeoxyg- 18 be helpful, as well as novel therapies directed against human or viral lucose ( F) positron emission tomography (FDG-PET), offer an 29 IL-6. Because the Kaposi sarcoma–associated herpes virus encodes important diagnostic biomarker algorithm. If the CSF is positive for kinase that phosphorylate nucleoside analogs such as zidvoudine for EBV by PCR and the FDG-PET (or thallium-201 scan) is also and ganciclovir, these have been used as part of rationally designed positive, the positive predictive value for AR-PCNSL approaches 33 interventions with some success. Although biopsy is always preferred and should be per- formed in all cases if feasible, if it is not possible, lymphoma therapy may be initiated in certain cases without further delay. If Conclusion both tests are negative, lymphoma is ruled out with near 100% For the most part, hematologic cancer therapeutic prospects are predictive value.
Scientists will appreciate the excellent podcast transcripts of the journal Nature (those published before July 2014; www buy arimidex 1 mg free shipping. The podcasts range in duration from 10 to 30 minutes buy arimidex with mastercard. Apart from high- quality documentaries generic arimidex 1 mg amex, which are rare, TV is a poor source of content, and most of us would prefer reading books or scientific journals. Suicide attacks in remote countries; minor earthquakes, tsunamis, or volcanic eruptions; old, helpless people murdered by drug-intoxicated gangs of youths; drug-intoxicated gangs of youths slain by paramilitary troops; paramilitary groups killed in an ambush by guerrilleros, etc. Imperfect though it may be, some broadcasts, for example TV news programmes, can nonetheless be outstanding speech trainers. The journalists talk continuously, there is no background music to spoil the sound of the speech, the language is standardised with only a few slang words, and the images provide you with important clues for understanding what’s going on. In addition, TV news provides all the ingredients of a classical soap opera: the players (politicians) and the content (political crises) are well known, and often you already know half of the story. My advice: Stop watching TV in your native language and start watching TV in your future language. The TV genres that serve your purpose most are the news and documentaries if you wish to become familiar with the language of the media and the language of science; and soap operas if you are interested in more colloquial language. Listen to your new TV programme for 15 to 60 minutes every day, starting on the very first day that you begin studying another language. Remember: it is all about word boundaries and speech sequencing, so try and discover your first words. As you will see later, identifying words inside the ‘speech soup’ is partly independent of knowing the meaning of the words. To summarise: • Human speech is a continuous sound stream. To understand the meaning, your built-in speech-recognition system cuts human speech into single words, matches them with your vast brain dictionary, and does all this more or less unconsciously at a rate of three words per second. Change your TV habits and watch TV exclusively in your new language. Again, teachers are of almost no help (see also the Teachers chapter below). Week after week, the sound pattern of words will flow into your brain. Again, your brain will be acting as a huge sponge, as cracking the code of human language is not a reserved hunting ground for infants and young children. With time, as comprehension sets in, British porridge slowly mutates into French Cuisine. So far, so good, you might think, but you have noticed something rather curious. You have been told to learn 5,000 to 15,000 words and complete a 1,500-hour speech recognition course, but nobody has asked you to say a single word. Legitimately, you wonder if you will one day be authorised to pronounce some of the words you have learned and to communicate your precious thoughts to other people. There are good reasons to restrain your desire to communicate. As you are a virgin – linguistically speaking – you might prefer to Print: Amazon. If you accept patience, my favourite prescription is a monastic ‘3-month silence’. Remember: you are not at school, there are no exams on the horizon, and you may therefore take a comfortable route when starting your new language. Concentrate on absorbing words, sounds and sentences, and, day after day, let the sound of the new language slowly sink in. Of course, you are too old for an exclusive baby approach to language learning, but for now, listen passively as young children do. Good pronunciation comes as a bonus of patient and attentive listening. So before you open your mouth, see in the next chapter what your eyes can do. Workload after Chapter 1–2 Speech-recognition training, typically 1,500 hours and more, can mostly be integrated into daily activities. Only about 100 hours of extra study time are needed as you become familiar with one or two language manuals. Adding these 100 hours to the initial workload defined in Chapter 1 (500 to 1,500 hours for importing 5,000 to 15,000 words into your word brain; see page 20), your total workload is now 600 to 1,600 hours Web: TheWordBrain. Her mhteor was ecsisxevely fnod of her; and her ghrodmentar doted on her slitl mroe. If you are a native English speaker, you will have recognised the initial sentences of Little Red Hood. If you are not, understanding the previous paragraph is more challenging, because your deciphering skill depends on the number of years you have been reading English. The original version: ‘Once upon a time there lived in a certain village a little country girl, the prettiest creature who was ever seen. Her mother was excessively fond of her; and her grandmother doted on her still more. Over decades of reading practise, your word brain has accumulated mental word-images of tens of thousands of words. When you read a text, you don’t spell the words, you see them. Each word is a pictogram like a toilet sign in airports, and slight variations of the pictogram are irrelevant for Print: Amazon. That is why our ‘cnortuy gril’ immediately evokes the correct image – and why proof-reading is so subtle. Word-images pass across our brain screen at a speed of 5 and more words per second and create mental images of things and events. We were too young – 4 to 8 years old – when we acquired this skill, and our memory of this seminal event has faded away.
Ultimately 1mg arimidex sale, understanding speciﬁc patient vulnerabilities most promising predictors are measures of physical function (task will help to: (1) predict treatment tolerance and beneﬁt for available speciﬁc or objectively measured) arimidex 1 mg on-line, cognition purchase arimidex 1mg without prescription, and symptoms. Cur- therapies, (2) inform novel clinical trial design to target speciﬁc rent evidence is limited to relatively small sample sizes, with few patient subgroups and explore the relationship between tumor and patients 80 years of age represented. Although validation is patient biology, and (3) identify targets for intervention to improve needed, available data can be used to begin to differentiate among supportive care during therapy (ie, exercise for physical ﬁt, vulnerable, and frail patients in the context of AML therapy. Hematology 2014 11 Disclosures choice, with physician advice, of either supportive care or low-dose Conﬂict-of-interest disclosure: The author declares no competing cytarabine for the treatment of older patients with newly diagnosed ﬁnancial interests. Intensive chemotherapy does not beneﬁt most older patients (age 70 years or older) with acute Correspondence myeloid leukemia. Klepin, MD, MS, Department of Internal Medicine, Section 18. Complete remission and early on Hematology and Oncology, Wake Forest School of Medicine, death after intensive chemotherapy in patients aged 60 years or older Medical Center Boulevard, Winston-Salem, NC 27157; Phone: with acute myeloid leukaemia: a web-based application for prediction of (336)716-4392; Fax: (336)716-5687; e-mail: hklepin@wakehealth. A novel prognostic model in References elderly patients with acute myeloid leukemia: results of 909 patients 1. Available from: http:// entered into the prospective AML96 trial. Age and acute myeloid of the survival of elderly patients with AML in the MRC AML11 and leukemia. Risk factors and decision therapy in 998 patients age 65 years or older with acute myeloid criteria for intensive chemotherapy in older patients with acute myeloid leukemia or high-risk myelodysplastic syndrome: predictive prognostic leukemia. On the value of intensive geriatric assessment for older adults receiving induction chemotherapy for remission-induction chemotherapy in elderly patients of 65 years with acute myelogenous leukemia. Wedding U, Rohrig B, Klippstein A, Fricke HJ, Sayer HG, Hoffken K. Organization for Research and Treatment of Cancer Leukemia Group. Impairment in functional status and survival in patients with acute 5. Survival for older patients with acute myeloid myeloid leukaemia. Hematopoietic cell transplantation leukemia: real world data on decision to treat and outcomes from the (HCT)-speciﬁc comorbidity index: a new tool for risk assessment before Swedish Acute Leukemia Registry. Comorbidity is an effective in select octogenarian acute myeloid leukemia patients: independent predictor of complete remission in elderly patients receiv- prognostic signiﬁcance of karyotype and selected molecular markers ing induction chemotherapy for acute myeloid leukemia. Addition of gemtuzumab transplantation comorbidity index score is predictive of early death and ozogamicin to induction chemotherapy improves survival in older survival in patients over 60 years of age receiving induction therapy for patients with acute myeloid leukemia. Effect of gemtuzumab ozogamicin importance of comorbidity for overall survival, complete remission, and on survival of adult patients with de-novo acute myeloid leukaemia early death in patients with acute myeloid leukemia. Shah A, Andersson TM, Rachet B, Bjorkholm M, Lambert PC. Survival older patients with acute myeloid leukemia: a retrospective study of and cure of acute myeloid leukaemia in England, 1971-2006: a associated treatment and outcomes. Outcome of older nonagenarian acute myeloid leukemia patients–predictive prognostic patients with acute myeloid leukemia: an analysis of SEER data over 3 models. Quality of life beyond 6 months chemotherapy toxicity in older patients: The Chemotherapy Risk after diagnosis in older adults with acute myeloid leukemia. Crit Rev Assessment Scale for High-Age Patients (CRASH) score. Predicting chemotherapy with similar quality of life and physical function compared to younger age during intensive chemotherapy for acute myeloid leukemia. Leuk toxicity in older adults with cancer: a prospective multicenter study. Predictors of early death cytarabine and hydroxyurea with or without all-trans retinoic acid for risk in older patients treated with ﬁrst-line chemotherapy for cancer. Azacitidine prolongs myelodysplastic syndromes and acute myeloid leukemia are highly overall survival compared with conventional care regimens in elderly predictive for outcome. Lower extremity function and 12 American Society of Hematology subsequent disability: consistency across studies, predictive models, and 40. Gait speed and survival in older value of gait speed alone compared with the short physical performance adults. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a 42. Implementing a geriatric predictor of subsequent disability. Kawas C, Karagiozis H, Resau L, Corrada M, Brookmeyer R. Reliabil- performance battery assessing lower extremity function: association ity of the Blessed Telephone Information-Memory-Concentration Test. Feasibility of geriatric assesse- predict survival in older allogeneic hematopoietic celltransplantation ment for older adults with acute myeloid leukemia (AML) receiving recipients. May 30 inpatients with acute myelogenous leukemia: a pilot study. In the pathogenesis of myeloma, the dialogue between plasma cells and their microenvironment is as important as the genotypic characteristics of the tumor clone. MM is genetically highly complex, with almost all patients displaying cytogenetic abnormalities and frequent intraclonal heterogeneity that play a critical role in the outcome of the disease. In fact, it is likely that myeloma will soon no longer be considered as a single entity. This, along with the availability of an unexpected number of new treatment possibilities, has reinforced the need for better tools for prognosis and for monitoring treatment efﬁcacy through minimal residual disease techniques. The outcome of MM patients has signiﬁcantly improved in the last 2 decades, ﬁrst through the introduction of high-dose therapy followed by autologous stem cell transplantation and, more recently, due to the use of proteasome inhibitors (bortezomib and carﬁlzomib) and immunomodulatory agents (thalidomide, lenalidomide, and pomalidomide). Moreover, the need to reexamine the diagnostic criteria of early MM and the possibility of early intervention opens up new therapeutic avenues.
Although the release; and (5) the cytotoxic agent or payload buy online arimidex. The beneﬁt of using fully human antibodies cheap arimidex uk, as opposed to chimeric and humanized versions order arimidex 1mg free shipping, has not been evident from clinical trials, possibly because of the fact that cancer patients with advanced disease have impaired ability to form antitherapeutic antibodies. The roles of intrinsic antibody effector functions and Fc receptor binding in ADC activity have also not been established deﬁnitively. The 3 ADCs that achieved FDA approval had very different antibody characteristics: GO (IgG4 subtype) has no effector function activity,3 brentuximab vedotin (IgG1 subtype) has modest antibody-dependent cellular phagocyto- sis only,23 and ado-trastuzumab (IgG1 subtype) emtansine is highly active in effector function assays. The ADC binds to tumor cell none has been speciﬁcally engineered to enhance effector function. Upon entry into degradative antibody fragments such as diabodies or minibodies on ADC compartments such as lysosomes, the drug can be released by linker activity. Cell death occurs once the drug mor penetration but more rapid clearance. ADCs in clinical development Drug Status Therapeutic area Target Cytotoxic class Brentuximab vedotin Approved HL, ALCL CD30 Auristatin Ado-trastuzumab emtansine Approved MBC HER2 Maytansine Inotuzumab ozogamicin Phase 3 ALL CD22 Calicheamicin BT-062 Phase 2 Multiple myeloma CD138 Maytansine CDX-011 Phase 2 Breast cancer GPNMB Auristatin PSMA ADC Phase 2 Prostate PSMA Auristatin DCDT2980S (RG7593) Phase 2 NHL CD22 Auristatin DCDS4501A (RG7596) Phase 2 NHL CD79b Auristatin Lorvotuzumab mertansine Phase 2 SCLC CD56 Maytansine Milatuzumab-dox Phase 2 Multiple myeloma CD74 Anthracycline (doxorubicin) SAR3419 Phase 2 DLBCL, ALL CD19 Maytansine SGN-75 Phase 1b RCC CD70 Auristatin AGS-16M8F Phase 1 RCC AGS-16 Auristatin ASG-22ME Phase 1 Solid tumors Nectin-4 Auristatin BAY-94-9343 Phase 1 Solid tumors Mesothelin Maytansine BIIB015 Phase 1 Solid tumors Cripto Maytansine IMGN529 Phase 1 NHL, CLL CD37 Maytansine IMGN853 Phase 1 Solid tumors Folate receptor-1 Maytansine IMMU-130 Phase 1 Colorectal CEACAM5 Camptothecin analog (SN-38) DSTP3086S (RG7450) Phase 1 Prostate cancer STEAP1 Auristatin DMUC5754A (RG7458) Phase 1 Ovarian cancer MUC16 Auristatin DNIB0600A (RG7599) Phase 1 Ovarian, lung cancer NaPi2b Auristatin SAR566658 Phase 1 Solid tumors CA6 Maytansine MLN0264 Phase 1 Colorectal cancer GCC Auristatin AMG 595 Phase 1 GBM EGFRviii Maytansine AMG 172 Phase 1 RCC CD70 (CD27L) Maytansine SGN-CD19A Phase 1 ALL, NHL CD19 Auristatin SGN-CD33A Phase 1 AML CD33 PBD dimer PF-0626350 Phase 1 Solid tumors 5T4 Auristatin IMMU-132 Phase 1 Epithelial cancers TROP-2/EGP-1 Camptothecin analog (SN-38) SC16LD6. These molecules will have signiﬁ- cant pharmacokinetic differences compared with ADCs, including In recent years, signiﬁcant effort has been devoted to developing rapid clearance and larger volume of distribution, as well as a lack site-speciﬁc conjugation methods either by introducing novel un- of immune effector functions. An example of this approach is paired cysteine residues or nonnatural amino acids that allow for vintafolide, which uses folic acid to deliver a vinblastine analog to orthogonal chemistry methods. Linker technology and drug release An ADC linker should function as a highly stable bridge between Chemical conjugation the antibody and payload that allows efﬁcient drug release upon Traditionally, drugs have been attached to antibodies using native delivery inside malignant cells. Early efforts to conjugate cytotoxic amino acids, taking advantage of the chemical reactivity of the agents to antibodies involved conditionally stable linkers, including ε-amino terminus of lysine residues or the sulfhydryl portion of a hydrazones that undergo cleavage under low pH conditions, such as reduced cysteine residue. GO was the ﬁrst such ADC to demonstrate stoichiometry and location of the resulting adducts represents a signiﬁcant clinical beneﬁt, targeting the CD33 antigen expressed on distribution across many of the lysine residues in the antibody. The hydrazone linker in this contrast, conjugation to reduced cysteines results in even-numbered drug was shown to be unstable,33 which may have compromised drug additions (ie, 2, 4, 6, or 8), depending on how many of the overall activity and contributed to nontarget toxicity. These additions occur in the stability has been obtained with cleavable peptides in combination hinge region of the antibody and have no impact on antigen binding with self-immolative groups that undergo intracellular enzymatic and little impact on binding to Fc receptors on immune cells. The most advanced example incorporating such a date, most ADCs have targeted an average of 4 drugs per antibody. Conﬂict-of-interest disclosure: The authors are employed by and have equity ownership in Seattle Genetics. Off-label drug use: Data are presented from clinical trials of antibody-drug conjugates that Cytotoxic agents have not been approved. The released drug or “payload” of an ADC must be present in sufﬁcient concentration inside the tumor cells to cause cell death. Correspondence Early attempts at ADCs included toxins such as ricin-A chain and 34 Jonathan Drachman, Seattle Genetics Inc, 21823 30th Dr SE, Pseudomonas exotoxin. These molecules posed challenges due to Bothell, WA 98021; Phone: 206-598-3300; Fax: 425-527-4315; immunogenicity. Subsequently, chemotherapy drugs such as Adria- 20 e-mail: jdrachman@seagen. However, these molecules proved to have insufﬁcient single-agent activity to justify further develop- ment. In the last 2 decades, it has become apparent that highly potent References 1. Building better magic bullets–improving unconju- cytotoxic agents ranging from 100-10 000 times more potent than gated monoclonal antibody therapy for cancer. Continuous cultures of fused cells proteolytic cleavage or acid hydrolysis. However, the drug exerts its secreting antibody of predeﬁned speciﬁcity. Identifying cytotoxic agents that are resistant to lysosomal proteases 3. Approval summary: gemtu- and are able to exit the lysosome (via diffusion or facilitated zumab ozogamicin in relapsed acute myeloid leukemia. Clin transport) are additional considerations for the design of ADCs. Final report of GO used calicheamicin, a DNA-damaging agent with highly potent 35 the efﬁcacy and safety of gemtuzumab ozogamicin (Mylotarg) cytotoxicity, as the payload. Systemic administration of the free in patients with CD33-positive acute myeloid leukemia in ﬁrst drug is not feasible due to toxicity, but by directing the drug to recurrence. A phase 3 study of achieve high concentrations in tumor cells. The 2 recently approved 11 12 gemtuzumab ozogamicin during induction and postconsolida- ADCs, brentuximab vedotin and ado-trastuzumab emtansine, tion therapy in younger patients with acute myeloid leukemia. This class of cytotoxic agents patients with acute myeloblastic leukemia who beneﬁt from the has an additional level of speciﬁcity in that it preferentially kills addition of gemtuzumab ozogamicin: results of the MRC proliferating cells by disrupting the mitotic spindle apparatus. Furthermore, malignant cells frequently have disrupted cell cycle 7. Addition of gemtu- checkpoints, increasing the sensitivity to mitotic catastrophe com- zumab ozogamicin to induction chemotherapy improves sur- pared with healthy cells. ADCs may be subject to many of the same potential mechanisms of 36 8. Effect of gemtuzumab resistance as standard chemotherapy agents. In addition, a poten- ozogamicin on survival of adult patients with de-novo acute tial mechanism of resistance to ADC therapy is the possible loss of myeloid leukaemia (ALFA-0701): a randomised, open-label, expression of the molecular target or down-modulation such that the phase 3 study. Addition of gemtu- each of these mechanisms of resistance affects the use of ADCs is zumab ozogamycin to chemotherapy improves event-free sur- currently being investigated. It is likely that the future of ADCs will vival but not overall survival of AML patients with intermedi- bring a diversity of payloads and new mechanisms of action, some ate cytogenetics not eligible for allogeneic transplantation: of which may be able to overcome acquired resistance. Gemtuzumab ozogamicin in acute Today, there are 2 ADCs available for patients in the United States. However, with more than 30 additional molecules in clinical trials Blood.