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Decitabine in the treatment of acute myeloid leukemia in elderly patients

Authors Malik P, Cashen A

Received 29 June 2013

Accepted for publication 2 September 2013

Published 3 February 2014 Volume 2014:6 Pages 53—61


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Priya Malik, Amanda F Cashen

Washington University School of Medicine, St Louis, MO, USA

Abstract: The majority of patients with acute myeloid leukemia (AML) are elderly and have a poor prognosis despite induction therapy. Decitabine, a DNA-hypomethylating agent that induces differentiation and apoptosis of leukemic cells, is a well-tolerated alternative to aggressive chemotherapy. It is currently FDA-approved for myelodysplastic syndrome, including patients with 20%–30% bone marrow blasts. Recent clinical attention has focused on evaluating decitabine as frontline therapy for untreated high-risk elderly AML patients. A large randomized international phase III study comparing decitabine to supportive care and cytarabine in elderly AML patients demonstrated significantly improved complete remission rates, but the survival difference did not reach significance. Due to this, decitabine did not achieve FDA approval for AML, but continues to be used off-label. Current research is focused on further defining subgroups of elderly AML patients who may derive greater benefit from decitabine therapy and combining it with other low-intensity active agents for AML.

Keywords: decitabine, elderly, AML

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