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Can Next-Generation Sequencing Help to Improve Outcomes in Elderly Patients With AML?

By: Joseph Fanelli
Posted: Tuesday, June 1, 2021

For elderly patients with acute myeloid leukemia (AML), genotyping by next-generation sequencing can be used to guide individualized, targeted therapy, potentially improving outcomes in this patient population, according to findings presented in the journal Hematology. Treatment with decitabine plus aclarubicin, cytarabine, and granulocyte colony-stimulating factor (DCAG) appears to be safe and effective in this patient population, noted Li Yu, MD, of the Shenzhen University School of Medicine, China, and colleagues.

“We suggest genotyping by next-generation sequencing first to guide individualized target therapy to solve the management dilemma of older AML patients,” the authors suggested. “Epigenetic mutations play an important role, and decitabine-based regimens can be used as alternative first-line chemotherapy for elderly patients.”

In this study, the authors used next-generation sequencing to identify the genetic features of elderly patients with AML and confirm the efficacy of chemotherapy based on molecular aberrations. The authors analyzed 111 genes relevant to hematologic malignancy and compared them in 52 elderly patients (≥ 60 years) and 161 younger patients (< 60 years).

The authors observed that adverse genetic alterations such as RUNX1 and secondary-type mutations in ASXL1, STAG2, and spliceosome were identified more often in elderly patients. In contrast, the frequency of WT1 mutations was much lower in the older patients. Epigenetic mutations such as DNMT3A, TET2, ASXL1, and IDH2 were also more common in elderly patients.

Additionally, 39 elderly patients received the decitabine-based chemotherapy; in these patients, the overall response rate was 76.9%, and the complete remission rate was 71.8%. The median overall survival for those patients was 12 months, and the 2-year overall survival probability was 20.5%.

Disclosure: The authors reported no conflicts of interest.


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