Changes to This Summary (04/17/2015)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Added Related Summaries as a new subsection
Added text to state that next-generation sequencing of AML genomes has identified an average of 13 mutations per case; mutated genes include transcription-factor fusions, nucleophosmin-1, tumor-suppressor, DNA-methylation-related, signaling, chromatin-modifying, myeloid transcription-factor, cohesion-complex, and spliceosome-complex (cited Cancer Genome Atlas Research Network as reference 13).
Added text to state that the hypomethylating agents decitabine and azacitidine are used in the population of older adults in the United States who decline intensive remission induction therapy or are considered unfit for intensive remission induction therapy. Also added that although the U.S. Food and Drug Administration's approval is for a myelodysplastic syndromes indication, the registration studies leading to approval included patients with 20% to 30% myeloblasts, or what would now be considered oligoblastic AML (cited Silverman et al. as reference 18 and 2006 Kantarjian et al. as reference 19).
Added text to state that one phase III trial randomly assigned 485 AML patients older than 65 years to receive decitabine or their preferred choice of either supportive care or low-dose cytarabine; median overall survival (OS) was not significantly improved for patients receiving decitabine compared withthe treatment of choice (cited 2012 Kantarjian et al. as reference 20). Also added that preliminary results from a phase III trial randomly assigned AML patients older than 65 years to azacitidine compared with conventional-care regimens of best supportive care, low-dose cytarabine, and 7+3 AML-type induction chemotherapy and similarly showed a nonsignificant difference in median OS for patients receiving azacitidine versus conventional care (cited Itzykson et al. as reference 21); low-dose cytarabine, decitabine, azacitidine, or best supportive care can be considered equivalently effective treatment approaches for older AML patients who decline traditional 7+3 induction chemotherapy.
Added text about treatment options for remission-induction therapy.
Added text to state that studies performed in the 1990s demonstrated that OS rates improved in patients receiving all-trans-retinoic acid (ATRA) in addition to chemotherapy (cited Adès et al. as reference 47 and Sanz et al. as reference 48).
Added text to state that the C9710 (NCT00003934) trial randomly assigned patients receiving ATRA and anthracyclines to two cycles of consolidation with or without arsenic trioxide (ATO); added statistical data about event-free survival (EFS) rates and overall survival rates at 3 years and the equivalent outcomes for higher- and lower-risk patients (cited Powell et al. as reference 49). Also added that a phase II study showed that incorporation of ATO in the primary management of acute promyelocytic leukemia (APL) patients could reduce the total amount of therapy administered (cited Gore et al. as reference 50).
Added text to state that this approach was investigated in a randomized, noninferiority trial that compared ATO plus ATRA with an ATRA-anthracycline-based regimen in patients with lower-risk APL. Also added EFS rates in the ATRA-ATO group and the ATRA-chemotherapy group and OS rates for ATRA-ATO patients at the median follow-up of 34.4 months (cited Lo-Coco et al. as reference 52).
Added text to state that most current regimens for the treatment of APL include some form of maintenance therapy, particularly for patients with higher-risk APL. Also added that a meta-analysis of randomized trials indicated that maintenance clearly improves disease-free survival (DFS) but not OS; these studies did not include ATO-containing trials.
Revised text to state that treatment options include ATRA plus ATO and ATRA plus anthracycline, followed by ATO-based consolidation therapy.
Added text to state that the standard postremission therapy for AML patients in remission is high-dose cytarabine; however, some controversy exists about whether it benefits all younger AML patients in first complete response versus selected subgroups, such as those with core-binding factor abnormalities (cited 2013 Löwenberg as reference 9, Weick et al. as reference 10, 2011 Löwenberg et al. as reference 11, Schaich et al. as reference 12, and Miyawaki et al. as reference 13).
Added further text about clinical and cytogenetic information that can define certain subsets of patients with predictable better or worse prognoses to include good-risk factors and poor-risk factors in those using postremission chemotherapy.
Added text to state that some patients induced into second remissions with ATO have experienced long-term DFS following autologous stem cell transplantation (cited Yanada et al. as reference 26).
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.