In a nutshell
This study is an update on the management of acute myeloid leukemia (AML). Researchers found that certain abnormal genes affect response to different medications used to treat AML.
Some background
Acute myeloid leukemia is a cancer of the bone marrow. It may be linked with abnormal genes that can affect response to treatment. Some genes are linked with worse outcomes. Some patients die soon after starting treatment (TRM – treatment-related mortality). Some patients stop responding to treatment over time. It is important to research drugs and genes in AML to find the most effective treatment.
Methods & findings
Different studies of AML treatment were analyzed. Factors that affect treatment response and different abnormal genes in patients with AML were assessed.
Therapy containing high doses of cytarabine (Cytosar-U), and fludarabine (Fludara) were linked with less TRM. One study found the number of patients over the age of 75 who stopped responding to treatment was similar to patients who had TRM in early treatment.
Studies showed that age is useful but not the most important factor in treatment response. Abnormal genes were strongly linked to treatment resistance. Abnormal TP53 gene was the most significant abnormal change that caused more treatment resistance. In contrast, 81% of patients who had an abnormal NPM1 gene had a good response to AML treatment.
In another study, 3277 patients with AML received midostaurin (Rydapt). 59% of these patients responded to treatment compared to 54% of the placebo (treatment with no effect). Midostaurin was found to be effective in patients with or without abnormal genes.
Combinations of chemotherapy and gemtuzumab ozogamicin (GO) (Mylotarg) were used in a study of 3325 patients with AML. Signs of cancer after treatment were less likely in these patients (55%) than those treated with chemotherapy alone (76%). Another study of 200 patients with AML reported that survival time without signs of cancer was longer in GO combined chemotherapy than chemotherapy alone.
A study of venetoclax (Venclexta) in 145 patients with AML and abnormal genes showed a complete response rate (no signs of cancer) of 35% and a complete response with an abnormal blood cell count of 66%.
A small study of 9 patients using dasatinib (Sprycel) to target abnormal genes had a response rate of 96%.
New drugs such as enasidenib (Idhifa) and ivosidenib are being studied and may be used for specific abnormal genes.
Currently, patients are assessed for markers of cancer in the blood after treatment. A stem cell transplant from the patient’s own cells is also recommended.
The bottom line
This study was a new update on the management of acute myeloid leukemia.
Published By :
American Journal of Hematology
Date :
Oct 01, 2018
