Genetic Data Helps to Improve Outcomes of Highly Lethal Acute Myeloid Leukemia

Patients with a blood cancer called acute myeloid leukemia who are positive for the TP53 gene are likely to respond well to the anticancer drug decitabine. The study indicating the same is published in the New England Journal of Medicine. Acute myeloid leukemia (AML) is a type of blood cancer that affects the red blood cells, white blood cells and platelets. It affects children as well as adults. The patient presents with symptoms of fever, weakness, weight loss, and easy bleeding. The diagnosis is based on examining a peripheral blood smear and a bone marrow sample.

AML has several subtypes associated with different genetic mutations. The subtypes differ in prognosis or the outcome for the patient. Tests like immunophenotyping are used to determine the subtype of AML. Cytogenetic tests and reverse transcription-polymerase chain reaction test (RT-PCR) are used to assess the genetic changes in these patients.

Treatment with chemotherapy results in remission of the cancer. However, the cancer can relapse again. Patients at a high risk for relapse can be treated with bone marrow transplantation during the remission period with chemotherapy.

One particular mutation, the TP53 mutation, makes the AML extremely difficult to treat. Patients with this type of mutation in their cancer cells are particularly resistant to treatment. They are often treated with aggressive chemotherapy which is obviously associated with several side effects. Even with this treatment, the average survival of these patients is around four to six months.

Researchers have now found out that AML patients with the TP53 mutation respond well to treatment with the anticancer drug decitabine. Decitabine is a relatively mild drug that is associated with lesser side effects. It is approved for the treatment of myelodysplastic syndrome, which often progresses to AML. However, it is also used by doctors for the treatment of AML especially in older patients.

The researchers conducted the study on 116 patients who either suffered from AML or myelodysplastic syndrome, which often leads to AML. They also studied the genetic mutations in the cancer cells.

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The researchers found that all the 21 patients with the TP53 mutation underwent remission with decitabine which lasted a little over a year. Though decitabine did not completely cure the cancer, it still has some advantages. Since the treatment is associated with lesser side effects, the patient can experience better quality of life with this treatment during the remission period. The remission caused by decitabine may also provide an opportunity to carry out bone marrow transplantation in these patients.

The result of the study also emphasizes the need to conduct research on AML patients, not as a group, but as smaller groups based on the genetic mutation. Larger studies that evaluate the use of decitabine in AML patients with the TP53 mutation will help to establish the use of the drug for these patients.

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References:

1. Welch JS et al. TP53 and Decitabine in Acute Myeloid Leukemia and Myelodysplastic Syndromes. N Engl J Med 2016; 375:2023-2036; DOI: 10.1056/NEJMoa1605949
2. General Information About Adult Acute Myeloid Leukemia - (https://www.cancer.gov/types/leukemia/patient/adult-aml-treatment-pdq)

Source-Medindia