A new study published randomly selected newly diagnosed Acute Myeloid Leukaemia (AML) patients to different intensified treatments

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Anticancer Fund

Acute myeloid leukaemia (AML) is one of the most common blood cancers in adults. The standard treatment, depending on age and disease sub-type, is high-dose induction chemotherapy to induce remission (no detectable disease) followed by a period of consolidation treatment (to keep the remission), also using high-dose chemotherapy, or high-dose chemotherapy with a bone-marrow transplant. Doctors have been attempting to improve remission and cure rates using more intense treatments with different protocols and drugs, but to date the results have been mixed and not generally accepted as definitive. A problem has been that many of the trials have been based on subsets of patients who have responded to previous treatments in one way or another, therefore making it difficult to conclude whether these different options would work for newly diagnosed patients who have not had any treatment.

A major new study, published in the journal Leukemia has attempted to address the issue by running a trial that has randomly selected newly diagnosed patients to different intensified treatments to see if any of them improve clinical outcomes (for example the period free of disease). The trial, carried out in multiple centres in Germany, included 3375 patients and assessed whether the treatments improved patient outcomes at five years. The results showed that the more intensive treatments had little impact and that none of them improved any of the clinical outcomes.

It is also worth noting that, for various reasons, many patients were unable to complete the treatment they were assigned to. This illustrates the fact that not every patient can actually undergo some types of treatment. Treatment side-effects, lack of response to drugs, complications and other events occurring during treatment will modify the type of treatment that the patient receives. This tells us that studies which conclude that one treatment is better than another by only looking at patients who actually complete treatments can be misleading by not counting those who have to stop or switch protocol. In contrast this study looked at all patients, including the relatively large numbers who were unable to complete treatments, therefore avoiding the distortion of results due to the number not completing treatment.

Professor Albrecht Reichle, one of the authors of the study, explained that: “Very few patients received their assigned therapies completely, predominantly because of a high rate of early treatment-failures, but also early toxicity and infections gave rise to treatment discontinuation. Nevertheless, dose-escalating randomized trials are still on the way. The general failure of the dose-escalation strategy suggests that new therapeutic strategies are needed if we are to improve outcomes of most persons with AML.”

 

Source: (abstract only)

http://www.ncbi.nlm.nih.gov/pubmed/26859081