Genetic features and efficacy of decitabine-based chemotherapy in elderly patients with acute myeloid leukemia

Objectives The outcome of elderly acute myeloid leukemia (AML) patients is poor, which was traditionally attributed to patient- and leukemia-related factors. However, studies about the genetic features of these elderly patients have not been integrated and the genetic mechanism of their poor outcome is less known. Methods Here, we used next generation sequencing (NGS) to identify the genetic features of elderly AML patients and confirmed the efficacy of chemotherapy based on molecular aberrations. Mutations in 111 genes relevant to hematological malignancy was analysed by virtue of NGS and the genetic differences were compared between elderly (n=52) and young (n=161) AML patients. Furthermore, the outcome of decitabine-based chemotherapy was identified in elderly patients. Results Frequencies of adverse genetic alterations, such as RUNX1 and secondary-type mutations (ASXL1, STAG2 and spliceosome), were much higher in elderly patients, while the frequency of WT1 mutations was much lower. Moreover, epigenetic mutations such as DNMT3A, TET2, ASXL1 and IDH2, were also more common in elderly patients. Furthermore, there were 39 elderly patients receiving the decitabine-based chemotherapy, and the results showed that the overall response rate (ORR) and complete remission rate (CR) were 76.9% and 71.8%, respectively. The median overall survival (OS) for those older patients was 12 months, and the 2-year OS probability was 20.5%. Discussion Our study provides deep understanding into the molecular mechanisms of the poor outcome of elderly AML patients. Conclusion Epigenetic mutations play an important role, and decitabine-based regimen can be used as alternative first-line chemotherapy for elderly patients.

Automated summary

Elderly AML patients have a higher frequency of adverse genetic alterations, such as RUNX1 and secondary-type mutations, while WT1 mutations are less common. Epigenetic mutations like DNMT3A, TET2, ASXL1, and IDH2 are also more prevalent in elderly patients. Decitabine-based chemotherapy showed promising results with an overall response rate of 76.9% and complete remission rate of 71.8%, with a median overall survival of 12 months and 2-year overall survival probability of 20.5% in elderly patients.