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A new era for AML?

Updated: Aug 24, 2020

There has been such a dramatic improvement in outcomes for so many haematological cancers in the past 10 years, it has been sad to see less progress with acute myeloid leukaemia. While targeted gene treatments and increasing safety and efficacy of transplantation has edged cure rates up in younger fit patients, the majority of people diagnosed with AML are over 65, and in this age group there has been little progress. Until now perhaps.


Traditional treatments with hydroxycarbamide tablets or low-dose cytarabine injections were fairly non-toxic, but never curative, 1-year survival rates around 5-20% at best. The advent of azacitidine injections, just a few years ago, can improve 1-year survival to 40-50%, and is sometimes very successful even in individual patients with the most challenging leukaemic mutations. It can cause uncomfortable or painful skin reactions in some.


Early results with venetoclax, published in trials last year, seem to have lifted the bar. Venetoclax is a tablet already established as very effective in patients with chronic lymphocytic leukaemia. Given alone in AML, its effects are modest - but improve when combined with low-dose cytarabine injections and perhaps even more so with azacitidine. In a trial published last year, complete remission rates (where the disease becomes "invisible" at the time of repeat testing) were around 70%, and 50% of patients were still alive at 17 months. Long-term results are unknown but given the tolerability of the added daily venetoclax tablets, this seems to be a positive step for this group. As with all areas of modern oncology, more work is needed to identify those who would most benefit from this and other targeted treatments.

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Search

A new era for AML?

Updated: Aug 24, 2020

There has been such a dramatic improvement in outcomes for so many haematological cancers in the past 10 years, it has been sad to see less progress with acute myeloid leukaemia. While targeted gene treatments and increasing safety and efficacy of transplantation has edged cure rates up in younger fit patients, the majority of people diagnosed with AML are over 65, and in this age group there has been little progress. Until now perhaps.


Traditional treatments with hydroxycarbamide tablets or low-dose cytarabine injections were fairly non-toxic, but never curative, 1-year survival rates around 5-20% at best. The advent of azacitidine injections, just a few years ago, can improve 1-year survival to 40-50%, and is sometimes very successful even in individual patients with the most challenging leukaemic mutations. It can cause uncomfortable or painful skin reactions in some.


Early results with venetoclax, published in trials last year, seem to have lifted the bar. Venetoclax is a tablet already established as very effective in patients with chronic lymphocytic leukaemia. Given alone in AML, its effects are modest - but improve when combined with low-dose cytarabine injections and perhaps even more so with azacitidine. In a trial published last year, complete remission rates (where the disease becomes "invisible" at the time of repeat testing) were around 70%, and 50% of patients were still alive at 17 months. Long-term results are unknown but given the tolerability of the added daily venetoclax tablets, this seems to be a positive step for this group. As with all areas of modern oncology, more work is needed to identify those who would most benefit from this and other targeted treatments.

34 views0 comments