PETHEMA-LMA10: Treatment of Acute Myeloblastic Leukemia (AML) in Patients Less Than or Equal to 65 Years
Status:
Recruiting
Trial end date:
2021-12-01
Target enrollment:
Participant gender:
Summary
Advances in the biological characterization of AML can now make a proper estimate of the risk
of recurrence and likelihood of survival of different groups of patients according to the
expression of different disease parameters. Karyotype, the molecular alterations affecting
genes FLT3, NPM1 and CEBPA, minimal residual disease by flow cytometry and response to first
induction cycle are variables that must be taken into consideration when planning the
treatment of first line from a patient with AML.
This breakthrough in the field of biology has not resulted yet in the development of new
drugs really effective in the treatment of AML. Therefore, the core of the treatment continue
to rely on the use of traditional chemotherapy combined or not with allogeneic hematopoietic
stem cell. Both treatments differ in their antileukemic efficacy, higher in aloTPH, as well
as their toxicity and procedure-related mortality, increased also in the aloTPH. These
aspects should be added that most candidates aloTPH patients lack an HLA identical sibling
donor forcing the search for alternative sources and hematopoietic stem cell donors. These
transplants alternative, but are not committed to their antileukemic efficacy, it does have
implied a greater toxicity. Therefore, the ultimate effectiveness of these procedures depends
largely on the proper selection of candidates for the same.
While there is broad agreement in terms of induction chemotherapy using a combination of
cytarabine with anthracycline, the choice of chemotherapy regimen is controversial
postremisión today. In the poor prognosis of itself involve the LMA, patients classified as
"favorable group" are acceptable disease-free survival with consolidation schemes involving
high-dose cytarabine. For other patients appear to be inappropriate to combine cytarabine
with an anthracycline, at least one cycle of consolidation, and raise the option of
allogeneic different depending on prognostic markers