TREATMENT OF LOW-BLAST COUNT AML USING HYPOMETHYLATING AGENTS

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Eleonora De Bellis
Luana Fianchi
Francesco Buccisano
Marianna Criscuolo
Luca Maurillo
Laura Cicconi
Mattia Brescini
Maria Ilaria Del Principe
Ambra Di Veroli
Adriano Venditti
Francesco Lo-Coco
Maria Teresa Voso *
(*) Corresponding Author:
Maria Teresa Voso | voso@med.uniroma2.it

Abstract

 

 

In 2002, the WHO classification reduced the proportion of blasts in the bone marrow (BM) necessary for the diagnosis of acute myeloid leukemia (AML) from 30% to 20%, eliminating the RAEB-t subtype of myelodysplastic syndromes (MDS). However, this AML subtype, defined as low-blast count AML (LBC-AML, with 20-30% BM-blasts) is characterized by peculiar features, as increased frequency in elderly individuals and after cytotoxic treatment for a different primary disease (therapy-related), poor-risk cytogenetics, lower white blood cell counts, and less frequent mutations of NPM1 and FLT3 genes. The clinical course of this entity is often similar to MDS with 10-19% BM-blasts. The hypomethylating agents azacitidine and decitabine have been shown to induce responses and prolong survival both in MDS and LBC-AML.  The role of these agents has been also demonstrated in AML with >30% BM-blasts, particularly in patients with poor-risk cytogenetics and in AML with myelodysplasia related changes. Most recent studies are evaluating strategies to improve outcome, including combinations of hypomethylating agents with immune-response checkpoint inhibitors, which have a role in cancer immune surveillance. Efforts are also ongoing to identify mutations which may predict response and survival in these patients.


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Author Biographies

Eleonora De Bellis, Università di Roma Torvergata

Istituto di Ematologia

Luana Fianchi, Università Cattolica del Sacro Cuore

Istituto di Ematologia

Francesco Buccisano, Università di Roma Torvergata

Istituto di Ematologia

Marianna Criscuolo, Università Cattolica del Sacro Cuore

Istituto di Ematologia

Luca Maurillo, Università di Roma Torvergata

Istituto di Ematologia

Laura Cicconi, Università di Roma Torvergata

Istituto di Ematologia

Mattia Brescini, Università di Roma Torvergata

Istituto di Ematologia

Maria Ilaria Del Principe, Università di Roma Torvergata

Istituto di Ematologia

Ambra Di Veroli, Università di Roma Torvergata

Istituto di Ematologia

Adriano Venditti, Università di Roma Torvergata

Istituto di Ematologia

Francesco Lo-Coco, Università di Roma Torvergata

Istituto di Ematologia

Maria Teresa Voso, Università di Roma Torvergata

Istituto di Ematologia, Associate Professor

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