Attempts to capitalize on known molecular aberrations in specific subtypes of AML include studies of imatinib in d KIT mutated FLT3 and AML inhibitors in E3 ligase inhibitor mutant AML. These generally include the novel therapies, azacitidine and decitabine, and the immunomodulatory derivative lenalidomide which are already approved and being used for myelodysplastic syndromes, together with hypomethylating agents. Hypomethylating agents Azacitidine was examined in a Phase III international test comparing azacitidine to main-stream care sessions including low-dose chemotherapy, most useful supportive care and intensive chemotherapy in patients with risky MDS or AML. The vast majority of patients were deemed unfit for intensive chemotherapy. At a median follow up of 20 months, people getting azacitidine had significantly prolonged overall survival with OS prices of fifty versus 160-hp, favoring azacitidine. This randomized trial showed good results for azacitidine and suggests that hypomethylating agents are a powerful strategy in patients unfit for intensive chemotherapy. 38 In a non randomized Phase II trial Metastatic carcinoma of untreated elderly patients with AML, decitabine monotherapy led to a CR rate of 25 percent consistently across all cytogenetic sub-groups. The median OS was 7. 7 weeks with the vast majority of toxicities linked to bone marrow suppression. Experts at M. N. Anderson conducted research of 81 patients with risky MDS or AML with abnormalities of chromosomes 5 or 7, with or without additional cytogenetic abnormalities. These patients were treated with one of many ALK inhibitor hypomethylating providers, often decitabine or azacitidine, as initial treatment. Yet another 151 people were treated with intensive induction chemotherapy. Retrospective analysis compared the outcome of those two groups and found no significant difference in CR rate or median duration of CR. But, overall survival favored the agents indicating a benefit to the usage of these agents specially in individuals with chromosome 5 or 7 abnormalities. Studies examining the effectiveness of sequential azacitidine plus lenalidomide in addition to decitabine in conjunction with other agents are ongoing. The adviser, lenalidomide, appears to affect the bone marrow microenvironment through things that are not well described. It is approved and efficient for MDS with 5q deletion in addition to multiple myeloma, and emerging data indicates a potential role in AML no matter 5q deletion status. In a phase I research in relapsed and refractory leukemia, patients received escalating doses of lenalidomide. The maximum tolerated dose was 50 mg daily. Sixteen % of AML patients achieved CR with reaction period from 5 to 14 months.