Acute Myeloid Leukemia (AML)
Leukemia Insights - Spring 2007
In AML several studies have confirmed the superiority of idarubicin over daunorubicin, and the value of high dose ara-C as consolidation in younger patients. A meta-analysis of different induction studies also indicated that high-dose ara-C induction improves remission duration in AML (Kern and Estey.Cancer 107:116, 2006). Therefore, in younger AML (age < 60 years) our frontline studies incorporate idarubicin and high-dose cytarabine as the backbone standard of therapy. We are currently investigating the potential value of adding sorafanib (a FLT3 / RAF inhibitor) to induction-consolidation therapy.
In elderly AML, intensive chemotherapy is associated with a high induction mortality. Our investigations focus on low intensity targeted strategies in patients who are not candidates for intensive chemotherapy. These strategies include clofarabine (adenosine nucleoside analog), decitabine (a hypomethylating agent), cloretazine (an alkylating agent), and tipifarnib (FTI inhibitor) plus low dose cytarabine.
- Idarubicin + cytarabine + sorafanib in AML < 60 years – protocol 2006-0977 (pending)
- Clofarabine in elderly AML – protocol 2006-0654
- Cloretazine in elderly AML – protocol 2006-0156
- Decitabine vs. low-dose ara-C in elderly AML – protocol 2005-0647
- Decitabine + valproic acid in high risk MDS/AML – protocol 2006-0686
In our studies of APL, we identified the combination of ATRA plus arsenic trioxide (+ mylotarg for high risk APL) to produce excellent results in APL. This is the basis for our ongoing study (Estey. Blood 107:3469, 2006). In AML with favorable karyotypes such as t(8;21) and inversion 16, our FLAG regimen has shown favorable results and continues as our frontline strategy.
- ATRA + AS2O3 + mylotarg in APL - protocol 2006-0706
- T(8;21), inversion 16 - protocol 2007-0147 (pending)
For AML in CR (any age), 2 maintenance strategies are being investigated, decitabine and PR1 vaccines.
- Decitabine vs. Best standard of care as maintenance for AML in CR1 and for subsequent CRs – protocol 2006-0358
- PR1 vaccine maintenance for AML in CR1 and HLA-A2 positivity – protocol 2006-0904