Decitabine appears to be as effective as high-dose chemotherapy in AML | City of health Berlin

Tuesday 5th July 2022 – Author: ham

Patients with acute myeloid leukemia (AML) require intensive chemotherapy before stem cell transplantation. High-dose chemo is a huge burden, especially for older people. Doctors are now reporting a more tolerable alternative.

In acute myeloid leukemia (AML), allogeneic blood stem cell transplantation still achieves the highest cure rates. Patients need high-dose chemotherapy early to kill as many blood cancer cells as possible. But because chemotherapy is often stressful, especially for older patients, a subsequent stem cell transplant is often no longer possible. This is why only a small fraction of the over 60s survive the diagnosis for more than five years.

More delicate alternative

Doctors at the University Hospital of Freiburg are now reporting a more tolerable but equally effective alternative to high-dose chemotherapy: it is the epigenetically active ingredient decitabine. The results of the study were presented on 11 June 2022 at the Congress of the European Society of Hematology (EHA) in Vienna: “For many elderly patients with acute myeloid leukemia, intensive chemotherapy is more of a burden than a long-term help. With our study, we show that there is a gentler alternative, “explains Prof. Dr. Michele Luebbert.

However, the chances of survival are slim

In the EORTC 1301 clinical trial, 606 patients over the age of 60 from eight European countries were initially treated with decitabine or standard chemotherapy for ten days. A stem cell transplant was then performed. Patients for whom this was not possible continued to receive decitabine or received up to three additional courses of chemotherapy. “With this study, we were able to establish a therapeutic sequence superior to classic intensive chemotherapy in older acute myeloid leukemia patients due to its better tolerability,” says Lübbert. There was no fundamental difference between chemotherapy and decitabine in terms of four-year survival (30 percent, 26 percent). However, serious side effects were less common with decitabine (3.6%) than with chemotherapy (6.4%).

More quality of life

Decitabine also belongs to the group of cytostatics. Contrary to conventional chemotherapy, the active ingredient does not immediately destroy cancer cells, but mainly affects which genes are transcribed in cancer cells, thus preventing their pathological proliferation. “With better tolerated therapy, patients can often lead their normal lives without a stressful hospital stay,” stresses cancer doctor Lübbert. In addition to healing, this is a very important goal for us ”.

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