When Bad is Better

Mutated gene a good sign for older leukemia patients too

Clara BloomfieldAlmost half of people younger than 60 with acute myeloid leukemia (AML) may be cured, but that number plunges to 5-16 percent for people 60 and older.

A study at the OSUCCC – James indicates that some older AML patients whose cancer cells have NPM1 gene mutations respond better to therapy and survive longer.

Mutations in this gene signal a favorable prognosis in younger patients with AML; this new study indicates that the same is true for older patients, suggesting that they should be offered stronger therapy.

“These findings were completely unexpected,” says study leader Clara D. Bloomfield, MD, a Distinguished University Professor who serves as cancer scholar and senior adviser to the OSUCCC – James. “Even patients over 70 who have NPM1 mutations do better than those with the normal gene. This study supports the importance of understanding and thinking positively about what we can do for older people with leukemia.”

Bloomfield and colleagues examined the outcomes of 148 AML patients 60 and older with normal cytogenetics, a feature seen in more than half of adults with AML. All of the patients had been treated through one of two national clinical trials sponsored by the Cancer and Leukemia Group B (CALGB).

Overall, 83 patients (56 percent) had NPM1 mutations. Of those, 84 percent had a complete remission, compared with 48 percent of patients whose cancer cells had a normal NPM1 gene. Patients with the mutated gene also had a significantly higher three-year survival rate: 35 percent compared with 8 percent.

“The favorable response of patients with NPM1 mutations suggests these mutations may represent a marker that can be used to stratify older patients with cytogenetically normal AML to intensive chemotherapy, which is often avoided in older patients,” says co-author Guido Marcucci, MD.

Published Feb. 1, 2010, in the Journal of Clinical Oncology.

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