Patients with the most lethal form of acute myeloid leukemia (AML) - based on genetic profiles of their cancers - typically survive for only four to six months after diagnosis, even with aggressive chemotherapy. But new research indicates that such patients, paradoxically, may live longer if they receive a milder chemotherapy drug. Treatment with the less intensive drug, decitabine, is not a cure. But surprisingly, AML patients whose leukemia cells carried mutations in a nefarious cancer gene called TP53 consistently achieved remission after treatment with decitabine. Their median survival was just over a year. The study, by a team of scientists at Washington University School of Medicine in St. Louis, was published online on November 23, 2016 in The New England Journal of Medicine. The article is titled “TP53 and Decitabine in Acute Myeloid Leukemia and Myelodysplastic Syndromes.” In AML, treatment involves intensive chemotherapy to try to kill the patient's leukemia cells and put the cancer into remission. If successful, a follow-up bone-marrow transplant can offer a possible cure, but this course of treatment is recommended only for patients with a high risk of relapse because the procedure can cause severe complications, even death. "What's really unique here is that all the patients in the study with TP53 mutations had a response to decitabine and achieved an initial remission," said the study's senior author, Timothy J. Ley, M.D., the Lewis T. and Rosalind B. Apple Professor of Medicine, noting that in AML, TP53 mutations have been correlated with an extremely poor prognosis.
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