Increased susceptibility to infections, high fever that does not disappear even with antibiotics, fatigue, difficulty in breathing, paleness, hemorrhagic syndrome. These are the most common symptoms of acute myeloid leukemia, a neoplastic disease of the bone marrow that affects about 3-4 people per 100 thousand inhabitants. “There are about 2,000 people a year in Italy affected by the disease which, if not treated, leads to death. In particular the elderly, it is no coincidence that the average age of onset is 68 years. But these patients are the most difficult to cure for two reasons: acute myeloid leukemia in the elderly, compared to that of the young, is intrinsically more aggressive, and from the point of view of therapies those who are older tolerate them less “. So at Adnkronos Salute Roberto Cairoli, director of the Hematology Department of the Niguarda Hospital in Milan, on the occasion of the month dedicated to raising awareness on blood cancers. From the point of view of treatments “we are in a moment of great ferment – underlines the hematologist – because until recently we had only a few classic chemotherapy drugs available, which in any case gave great satisfaction”. The therapy for acute myeloid leukemia “is divided into different phases – explains Cairoli – The first phase is the so-called induction therapy, whose goal is the apparent disappearance of the disease. If after this phase a consolidation therapy is not given. disease returns in a short time. In induction therapy two chemotherapy drugs (anthracyclines and Ara-C) have been used since 1973, which together induce a complete remission in about 60% of cases, with a chance of survival to 5 years of 50% in younger patients “. Many others have been associated with these drugs, especially in recent years – continues the specialist – Some are ‘molecular target’ drugs, that is, they affect a biological characteristic identified in the malignant cell, inducing its death. There is a combination of drugs which is particularly important in the care of the elderly patient. This therapy is based on inhibitors of BCL2, a substance that is overexpressed inside the leukemia cell, in association with hypomethylating chemotherapy (the DNA of the leukemia cell is pathologically hypermethylated). these drugs induce a remission of the disease in 60% of elderly patients, results that have never been seen before. Therefore the mix modernly adopted in the elderly patient is the association of a hypomethylating drug with a BCL2 inhibitor called venetoclax ” . The ‘defect’ of this therapy “is that it is not of a fixed duration. It is in fact a continuous therapy, this means that the patient 7 days a month must go to the clinic to undergo the treatment. Then there are several other substances that in various combinations have improved the survival of acute myeloid leukemia patients, both young and elderly. ” When the disease is in the active phase “the patient is generally hemorrhagic, febrile and anemic – continues Cairoli – So he has to have blood and platelet transfusions, he is very ill. The goal of therapy is instead to improve the quality of life of who is affected by acute myeloid leukemia, but to do so you must first make the patient independent of transfusion support. If you have a fever or an intercurrent infection, our job is to improve the number and performance of white blood cells, so that these intercurrent episodes and the fever can disappear. With no more fever and no more having to resort to transfusions of red blood cells and platelets, even if the patient has to periodically go to the clinic for treatment, his quality of life improves enormously “. It must be said, however, that “we do not get this result in 100% of patients – specifies the hematologist – but in over half of the cases”. The therapy that associates a hypomethylating drug with venetoclax “produces results that we have never seen in terms of remission, but it is a continuous therapy – Cairoli reiterates – Venetoclax is taken by mouth while hypomethylating therapy is done subcutaneously 7 days every 28 at a hematology clinic. In the future it will be possible to take the therapy directly at home: research is working hard to achieve this goal “.