Long-term decitabine/retinoic acid maintenance treatment in an elderly sAML patient with high-risk genetics

Abstract

Elderly patients with AML ineligible for induction have a dismal prognosis; hence disease stabilization is a primary treatment goal. This case of a 75-year-old patient with secondary AML receiving the combination of decitabine and ATRA (within the DECIDER trial, NCT00867672) demonstrates an above-average survival. The therapy administered over 52 cycles led to complete molecular and hematological remission and resulted in 5.3 years overall survival. Clonal evolution of the leukemic clone could be demonstrated using DNA sequencing methods. According to the literature, this case constitutes the longest continued HMA exposure in an elderly AML patient ineligible for standard chemotherapy.

Fig. 1

A Cytological diagnosis of tAML. Left panel myeloblast in PB smear, middle panel population of blasts (> 50%) in BM (Pappenheim-staining), right panel POX-positive blasts in BM (POX-staining), original magnification × 63. B Best response to DAC + ATRA. Left panel PB smear with mature neutrophil granulocyte, right panel BM with normal trilineage hematopoiesis (Pappenheim-staining), original magnification × 40. C Kinetics of Hgb level (upper graph, red line), RBC transfusion requirements and timepoints of inpatient hospitalization. Bars depicting each DAC cycle (blue d1-5, orange d1-3). Lower graph showing proportion of del(5q) (blue line) detected with FISH, emerging mutations are depicted at the timeline. Timeframe over 5 years from therapy initiation with DAC + ATRA until patient deceased. Hgb Hemoglobin, PB Peripheral blood, POX Peroxidase, RBC Red blood cell