Acute Myeloid Leukemia

Acute myeloid leukemia (AML) is a cancer of the myeloid line of blood cells; characterized by the rapid growth of abnormal cells that build up in the bone marrow and blood and interfere with normal blood cells. Symptoms may include feeling tired, shortness of breath, easy bruising and bleeding, and increased risk of infection. Occasionally, spread may occur to the brain, skin, or gums. As an acute leukemia, AML progresses rapidly and is typically fatal within weeks or months if left untreated. Risk factors include smoking, previous chemotherapy or radiation therapy, myelodysplastic syndrome, and exposure to the chemical benzene.

Arsenic trioxide in cases that have recurred

The underlying mechanism involves replacement of normal bone marrow with leukemia cells, which results in a drop in red blood cells, platelets, and normal white blood cells. Diagnosis is generally based on bone marrow aspiration and specific blood tests. AML has several subtypes for which treatments and outcomes may vary. AML typically is initially treated with chemotherapy, with the aim of inducing remission. People may then go on to receive additional chemotherapy, radiation therapy, or a stem cell transplant. The specific genetic mutations present within the cancer cells may guide therapy, as well as determine how long that person is likely to survive.

Arsenic trioxide may be tried in cases that have recurred following usual treatments. In 2015, AML affected about one million people and resulted in 147,000 deaths globally. It most commonly occurs in older adults. Males are affected more often than females. AML is curable in about 35% of people under 60 years old and 10% over 60 years old. Older people whose health is too poor for intensive chemotherapy have a typical survival of 5–10 months. It accounts for roughly 1.8% of cancer deaths in the United States. According to results from a clinical trial published in Lancet Haematology, 5-day and 10-day decitabine schedules may have similar efficacy and safety in older patients with acute myeloid leukemia.

60 years or older unsuitable for intensive chemotherapy

Firstly, the single center, open label, randomized phase 2 trial was conducted at the University of Texas MD Anderson Cancer Center in Houston. Eligible patients with newly diagnosed acute myeloid leukemia were younger than 60 years of age and deemed unsuitable for intensive chemotherapy with an anthracycline plus cytarabine or 60 years or older and deemed unsuitable for intensive chemotherapy. For induction therapy, patients received 20 mg/m² decitabine intravenously for 5 or 10 consecutive days every 4 to 8 weeks for up to 3 cycles. Patients who responded to the therapy continued to receive decitabine on a 5-day schedule as consolidation therapy for up to 24 cycles.

So, the primary endpoint was a composite of complete remission; complete remission with incomplete platelet recovery; and complete remission with incomplete hematologic recovery. Firstly, the study enrolled 71 patients. So, after randomization, 28 and 43 patients received decitabine for 5 and 10 days, respectively. The 2 treatment groups showed no significant difference in the proportion of patients that achieved the composite primary endpoint (5-day, 12/28 [43%]; 10-day, 17/43 [40%]; =.78).  Overall survival at 1 year was 25% for both groups. This is to say, that Neutropenic fever (5 day, 25%; 10 day, 33%) and infection (5 day, 18%; 10 day, 37%) were the most common grade 3 and 4 adverse events. One patient (4%) died from sepsis in the 5-day group, and 6 patients (14%) died from infections in the 10-day group. No deaths had relation to the treatments.