Acute myeloid leukemia (AML) is a type of blood cancer characterized by increased amounts of immature blood cells occupying the bone marrow leading to anemia, increased frequency of infections and increased risk of bleeding. Treatment of AML primarily consists of intensive chemotherapy.
However, older patients with AML are often not fit enough to undergo intensive chemotherapy due to high risk of toxicity and complications. About a decade ago the hypomethylating agent decitabine was added to the treatment armamentarium of AML. The aim of this thesis of Jacobien Hilberink was to evaluate several aspects in the treatment of AML with decitabine in the older patient population. Our results show that older AML patients treated with decitabine can achieve complete remission of disease, although not curative.
Additionally, our research stresses the importance of consolidating with an allogeneic hematopoietic cell transplantation which leads to significantly longer survival irrespective of chemotherapy or decitabine induction treatment. Furthermore, we show that minimal residual disease prior to conditioning for allogeneic hematopoietic cell transplantation is not predictive of relapse nor survival in the context of decitabine induction therapy. Looking beyond the effect of decitabine on leukemic blasts we evaluated the effect of decitabine on macrophages, immune cells present in the bone marrow environment.
In conclusion, this thesis shows the significant added value of decitabine in the treatment of older patients with AML.
