TREATMENT OF ACUTE MYELOID LEUKEMIA WITH 20-30% BONE MARROW BLASTS

Luca Maurillo, Francesco Buccisano, Maria Ilaria Del Principe, Chiara Sarlo, Luigi Di Caprio, Concetta Ditto, Federica Giannotti, Daniela Nasso, Eleonora Ceresoli, Massimiliano Postorino, Marco Refrigeri, Sergio Amadori, Adriano Venditti
  • Francesco Buccisano
    Cattedra di Ematologia, Università di Tor Vergata, Rome, Italy
  • Maria Ilaria Del Principe
    Cattedra di Ematologia, Università di Tor Vergata, Rome, Italy
  • Chiara Sarlo
    Cattedra di Ematologia, Università di Tor Vergata, Rome, Italy
  • Luigi Di Caprio
    Cattedra di Ematologia, Università di Tor Vergata, Rome, Italy
  • Concetta Ditto
    Cattedra di Ematologia, Università di Tor Vergata, Rome, Italy
  • Federica Giannotti
    Cattedra di Ematologia, Università di Tor Vergata, Rome, Italy
  • Daniela Nasso
    Cattedra di Ematologia, Università di Tor Vergata, Rome, Italy
  • Eleonora Ceresoli
    Cattedra di Ematologia, Università di Tor Vergata, Rome, Italy
  • Massimiliano Postorino
    Cattedra di Ematologia, Università di Tor Vergata, Rome, Italy
  • Marco Refrigeri
    Cattedra di Ematologia, Università di Tor Vergata, Rome, Italy
  • Sergio Amadori
    Cattedra di Ematologia, Università di Tor Vergata, Rome, Italy
  • Adriano Venditti
    Cattedra di Ematologia, Università di Tor Vergata, Rome, Italy

Abstract

Patients with ≥ 20% <30% bone marrow blast infiltration previously regarded as a transitional category between myelodisplasia and acute myeloid leukemia (AML) according to FAB classification, have been subsequently included into AML WHO classification. However, controversies still remain as to whether the natural history and responsiveness to therapy of these patients is comparable to that of patients with > 30% BM blast AML. In the present review, we will discuss the clinical results achieved in the treatment of elderly patients with 20%-30% BM blasts AML using intensive chemotherapy (IC) or hypomethylating agents. Overall, due to concerns of treatment-related morbidity and mortality associated with delivery of IC, approximately only 30% of all patients ≥ 65 years are considered eligible for this approach. Therefore, a great deal of attention has been dedicated to hypomethilating agents such as azacitidine and decitabine. These agents have shown efficacy, with reduced toxicity as compared with IC, when administered to elderly patients not eligible for IC and with 20-30% BM blasts and multilineage dysplasia. Future randomized clinical trials are eagerly awaited to determine whether hypomethylating agents can substitute for IC even in elderly patients with good functional status.

Keywords

Acute myeloid leukemia, Refractory anaemia with excess of blasts in transformation, World Health Organization classification

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Submitted: 2014-06-13 09:54:24
Published: 2013-06-03 00:00:00
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