Aggressive therapy best for certain AML patients

-looking chromosomes. These cells lack the microscopic chromosome damage that guide therapy.

In 1994, however, a team of researchers that included Bloomfield discovered the MLL-PTD mutation in these patients. It was the first clinically useful marker to be identified in cases of AML with normal-looking chromosomes, and it was found to predict a short remission and poor response to therapy. About 8 percent of AML patients with normal-looking chromosomes have the mutation.

Studies done eight to 10 years ago showed that nearly 100 percent of these patients relapsed and died within two years, says first author Susan P. Whitman, a research scientist at Ohio State's Comprehensive Cancer Center.

This retrospective study set out to learn whether aggressive therapy provided through two CALGB clinical trials benefits patients with the mutation. It evaluated 238 people aged 18 to 59 with AML and normal-looking chromosomes. Of these, 24 (10 percent) had the MLL-PTD mutation.

All patients received an initial aggressive chemotherapy regimen (i.e., induction therapy) to induce remission. Those who achieved remission then received further aggressive therapy (i.e., consolidation therapy), usually an autologous stem cell transplant, with a few receiving intensive chemotherapy.

Of the 24 patients with the mutation, 22 had a complete remission. Of those, 13 relapsed within 1.4 years, but nine (41 percent) remained in remission when the study ended, with disease-free periods ranging from two to almost eight years.

We believe that the use of aggressive consolidation therapy may have contributed to the reduced number of early relapses in these patients, Bloomfield says.

We still must do larger studies to confirm these findings, to better understand this disease and to develop curative targeted therapies.


Contact: Eileen Scahill
Ohio State University

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