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27 January 2017

A process described as a "knowledge bank" could radically improve treatment for patients with acute myeloid leukaemia by constant updating of information, British researchers have reported.

A team led by researchers, from Cambridge, UK, described yesterday how they developed a bank based on information about some 1,500 patients with the disease.

The bank was used to predict the best treatment for each patient, stem cell replacement or chemotherapy, calculating risks and benefits.

The researchers conclude that banks of up to 10,000 patients would be needed to obtain precise prognostic advice.

But, they say, according to their study about one third of patients would have been prescribed a different treatment. The findings were reported in Nature Genetics.

They believe the knowledge bank approach would reduce the proportion of AML patients needing stem cell therapy by about a tenth.

The patients in the study had taken part in clinical trials in Germany and Austria - giving the researchers information about genetic features, treatment schedules and outcomes.

Researcher Dr Peter Campbell, from the Wellcome Trust Sanger Institute, said: “The knowledge bank approach makes far more detailed and accurate predictions about the likely future course of a patient with AML than what we can make in the clinic at the moment.

"Current guides use a simple set of rules based on only a few genetic findings. For any given patient, using the new tool we can compare the likely future outcomes under a transplant route versus a standard chemotherapy route – this means that we can make a treatment choice that is personally tailored to the unique features of that particular patient.”

Fellow researcher Dr Hartmut Döhner, of the University of Ulm, Germany, said: “Building knowledge banks is not easy. To get accurate treatment predictions you need data from thousands of patients and all tumour types. Furthermore, such knowledge banks will need continuous updating as new therapies become approved and available.

"As genetic testing enters routine clinical practice, there is an opportunity to learn from patients undergoing care in our health systems. Our paper gives the first real evidence that the approach is worthwhile, how it could be used and what the scale needs to be.”

And another of the researchers, Dr Moritz Gerstung, of the European Bioinformatics Institute, said: “It has long been recognised that cancer is a complex genetic disease. Our study provides an example of how detailed genetic and clinical information can be rationally incorporated into clinical decisions for individual patients.

"We tested this philosophy in one type of leukaemia, but the concept could theoretically be applied in other cancers with difficult clinical decisions as well. Our analysis reveals that knowledge banks of up to 10,000 patients would be needed to obtain the precision needed for routine clinical application.”

Moritz Gerstung and Elli Papaemmanuil et al. Precision Oncology in acute myeloid leukemia using a knowledge bank approach. Nature Genetics 17 January 2017; doi: 10.1038/ng.3756


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