When David Stan was diagnosed with acute myeloid leukemia (AML) in the summer of 2023, his family faced a daunting challenge after initial treatments failed. Standard chemotherapy proved ineffective, and the cancer spread to his brain and spinal fluid, leaving few options. Hope was renewed when they sought treatment at MD Anderson Cancer Center, where he was enrolled in an early-phase clinical trial.
Experimental Therapy Leads to Remission
Under the care of Dr. Branko Cuglievan, David received a combination therapy featuring revumenib (SNDX-5613), a menin inhibitor, along with venetoclax and decitabine/cedazuridine. Revumenib has shown promise in other clinical trials, but its effects have been short-lived when used alone. Dr. Cuglievan's approach combined revumenib with two other drugs to improve efficacy. This novel combination yielded remarkable results: within two weeks, David's bloodwork showed no evidence of disease, and his spinal fluid was clear.
"Patient response to revumenib has been good in other clinical trials," explained Cuglievan. "But it’s also been short-lived when used alone. We thought we could do better. So, we combined it with two other drugs. And we’ve gotten such good results, this may well become the new standard of care."
Stem Cell Transplant and Subsequent Challenges
Achieving full remission made David eligible for a stem cell transplant, which he received from an unrelated donor on April 25, 2024. Although the transplant was successful, David experienced severe mucositis and a BK virus infection. The mucositis, an inflammation of the digestive tract, was managed with pain relievers and IV fluids. The BK virus infection, a common issue in immunocompromised patients, was addressed through another clinical trial involving cytotoxic T lymphocytes (CTLs) specifically reactive to the BK virus. After two infusions, the infection cleared completely.
Recovery and Future Outlook
Today, David remains in full remission, with his blood counts continuing to improve. He is regaining his strength and looking forward to resuming normal activities. His experience has even inspired him to consider a career in medicine, with aspirations of becoming a pediatrician and helping other cancer patients.
David's successful treatment underscores the potential of menin inhibitors in combination with other targeted therapies for treating AML with KMT2A mutations. This approach offers new hope for patients with relapsed or refractory AML, where conventional treatments have failed.
