The first 60 days: IDH1- and IDH2-mutated acute myeloid leukaemia

Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.

• Newly diagnosed IDH1-mutated, unfit for intensive chemotherapyNCCN Guidelines: Acute Myeloid Leukemia

  Ivosidenib plus azacitidine (AGILE) or venetoclax plus azacitidine; triplets in trials.

  IvosidenibAzacitidineAGILEVenetoclaxVIALE-A
• Newly diagnosed, fit for intensive chemotherapyNCCN Guidelines: Acute Myeloid Leukemia

  7+3 induction with consolidation and transplant by ELN risk; IDH inhibitors added in trials.

  Cytarabine + anthracycline ('7+3')Allogeneic stem cell transplantationIvosidenib

These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.

• Medical oncologistNamed in the standard of care for: Newly diagnosed IDH1-mutated, unfit for intensive chemotherapy, Newly diagnosed, fit for intensive chemotherapy, Relapsed or refractory.
• Transplant and cell therapy teamNamed in the standard of care for: Newly diagnosed, fit for intensive chemotherapy, Relapsed or refractory.

A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.

Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.

1. 1.Relapsed or refractoryNCCN Guidelines: Acute Myeloid Leukemia

   Ivosidenib or olutasidenib for IDH1, enasidenib for IDH2; venetoclax-based combinations; transplant in responders.

   IvosidenibOlutasidenibEnasidenibVenetoclaxAllogeneic stem cell transplantation

Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.

Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.

• A Study to Evaluate HMPL-306 in Patients With IDH1or IDH2-mutated Acute Myeloid LeukemiaPhase 3 · recruiting · NCT06387069A Multicenter, Randomized, Open-Label, Phase III Clinical Study to Evaluate the Efficacy and Safety of HMPL-306 vs. Salvage Chemotherapy Regimens in Patients With IDH1- and IDH2-mutated Relapsed/Refractory Acute Myeloid Leukemia (R/R AML)
• myeloMATCHPlatform trial · recruiting · NCT05564390Newly diagnosed AML and MDS: genomic screening at diagnosis assigns patients to tiered, biomarker-defined sub-studies from induction through MRD-guided consolidation and maintenance
• A Study to Assess the Safety and Efficacy of Two Combinations of Isocitrate Dehydrogenase (IDH) Mutant Targeted Therapies Plus Azacitidine in Participants With Newly Diagnosed Acute Myeloid Leukemia (AML) Harboring IDH Mutations Who Are Not Candidates to Receive Intensive Induction ChemotherapyPhase 1/2 · active · NCT02677922A Phase 1b/2 Open-Label, Randomized Study of 2 Combinations of Isocitrate Dehydrogenase (IDH) Mutant Targeted Therapies Plus Azacitidine: Oral AG-120 Plus Subcutaneous Azacitidine and Oral AG-221 Plus SC Azacitidine in Subjects With Newly Diagnosed Acute Myeloid Leukemia Harboring an IDH1 or an IDH2 Mutation, Respectively, Who Are Not Candidates to Receive Intensive Induction Chemotherapy

Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.

• Free in oncologyFree testing, helplines, rides and lodging, second opinions and trial travel help, with who is eligible.
• Financial helpManufacturer programmes, national schemes and charities by country and product.
• Second opinionExpert centres for this cancer in your country and how referral works.

• IDH1- and IDH2-mutated acute myeloid leukaemia: the full pageIDH-mutated acute myeloid leukaemia has a faulty metabolic enzyme that floods cells with a chemical that blocks maturation. Pills that shut the enzyme off, ivosidenib for IDH1 and enasidenib or olutasidenib for IDH2 and IDH1, let the leukaemia cells mature, and ivosidenib with azacitidine tripled survival in older patients.
• One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
• Treatment sequencingWhich treatment tends to follow which, line by line.
• NavigatorStandard of care for your stage, what you have tried, and trials near you.