Wie entsteht Schmerz? Und wie kann man ihn lindern? Um diese Fragen beantworten zu können, untersuchen Forscher eine Gruppe von Schlüsselmolekülen, die Eicosanoide, und ihre Abbauprodukte. Dabei machen sie immer wieder überraschende Entdeckungen: Blockiert man etwa durch Schmerzmittel wie Acetylsalicylsäure gezielt die Entstehung des Abbauprodukts Prostaglandin, schützt dies auch vor Krebs. Verhindert man die Entstehung von Leukotrienen, lassen sich allergische Reaktionen wie Asthma, aber auch Krebs, Osteoporose und Herz-Kreislauf-Erkrankungen beeinflussen.
The aim of this clinical trial was to evaluate the impact of all-trans retinoic acid (ATRA) in combination with chemotherapy and to assess the NPM1 status as biomarker for ATRA therapy in younger adult patients (18-60 years) with acute myeloid leukemia (AML). Patients were randomized for intensive chemotherapy with or without open-label ATRA (45 mg/m2, days 6-8; 15 mg/m2, days 9-21). Two cycles of induction therapy were followed by risk-adapted consolidation with high-dose cytarabine or allogeneic hematopoietic cell transplantation. Due to the open label character of the study, analysis was performed on an intention-to-treat (ITT) and a per-protocol (PP) basis. One thousand one hundred patients were randomized (556, STANDARD; 544, ATRA) with 38 patients treated vice versa. Median follow-up for survival was 5.2 years. ITT analyses revealed no difference between ATRA and STANDARD for the total cohort and for the subset of NPM1-mutated AML with respect to event-free (EFS; p = 0.93, p = 0.17) and overall survival (OS; p = 0.24 and p = 0.32, respectively). Pre-specified PP analyses revealed better EFS in NPM1-mutated AML (p = 0.05) and better OS in the total cohort (p = 0.03). Explorative subgroup analyses on an ITT basis revealed better OS (p = 0.05) in ATRA for genetic low-risk patients according to ELN recommendations. The clinical trial is registered at clinicaltrialsregister.eu (EudraCT Number: 2004-004321-95).