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

Tuesday July 5, 2022 – Author:

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

In acute myeloid leukemia (AML), the allogeneic blood stem cell transplantation still have the highest cure rates. Patients need high-dose chemotherapy beforehand 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. That is why only a small proportion of those over 60 survive the diagnosis for more than five years.

Gentler alternative

Doctors at the Freiburg University Hospital are now reporting on a more tolerable but equally effective alternative to high-dose chemotherapy: it is the epigenetically active active substance decitabine. The study results were presented on June 11, 2022 at the Congress of the European Society of Hematology (EHA) in Vienna: “For many older AML patients, 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. Michael Luebbert.

The chances of survival are slim anyway

In the EORTC 1301 clinical study, 606 patients over the age of 60 from eight European countries were initially treated with either decitabine or standard chemotherapy for ten days. A stem cell transplant was then performed. Patients for whom this was not possible either continued to receive decitabine or received up to three further chemotherapy cycles. “With this study, we were able to establish a therapy sequence that is superior to classic intensive chemotherapy in older AML patients due to its better tolerability could be,” 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 percent) than with chemotherapy (6.4 percent).

More quality of life

Decitabine also belongs to the group of cytostatics. In contrast to conventional chemotherapy, the active substance does not destroy the cancer cells immediately, but primarily influences which genes are transcribed in the cancer cells and thus prevents their pathological proliferation. “With the better tolerated therapy, patients can often lead their normal lives without stressful inpatient stays,” emphasizes cancer doctor Lübbert. In addition to healing, that is a very important goal for us.”

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