SUS starts offering combined therapy for acute myeloid leukemia in adults with restrictions on chemotherapy
The Unified Health System (SUS) now offers the use of the drug venetoclax in conjunction with azacitidine, a new approach for adult patients newly diagnosed with acute myeloid leukemia (AML). The therapy is specifically aimed at individuals who cannot undergo intensive chemotherapy.
The measure was formalized with the publication of the decision this past Monday (15). According to the official ordinance, the technical sectors of the Ministry of Health have up to 180 days to organize and implement the availability of treatment throughout the public network.
This important incorporation will benefit a particular group of patients who are not considered suitable for traditional, generally more aggressive, chemotherapy regimens. This inability may be due to advanced age, clinical frailty or the presence of other pre-existing health conditions, which previously severely limited treatment options.
Acute myeloid leukemia is a type of cancer that develops in the bone marrow, the tissue vital for the production of all blood cells. The condition progresses when abnormal cells multiply out of control, disrupting the normal manufacturing of red blood cells, white blood cells and platelets.
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Understanding the different types of leukemia
Although leukemia is often viewed as a single disease, it comprises several categories of cancer that affect the blood. Experts usually classify the condition into two main groups: acute and chronic leukemias. Each of these subdivisions can also be myeloid or lymphoid.
Acute forms of the disease originate in young cells and progress rapidly, requiring medical intervention and immediate treatment to control its progression.
In contrast, chronic leukemias develop more gradually and, in many cases, may not show symptoms for several months or even years, making diagnosis more challenging.
Onco-hematologist Breno Gusmão, who works at Beneficência Portuguesa in São Paulo and is a member of the Abrale Medical Committee, explained to g1 that “acute leukemias represent clinical emergencies due to their abrupt reproduction and the need for aggressive and immediate treatment. Chronic leukemias, more common in older people, allow for smoother management with current treatments.”
The distinction between myeloid and lymphoid leukemias also has clinical relevance. Myeloid affects the precursor cells that give rise to red blood cells, platelets and some classes of white blood cells. Lymphoids, in turn, reach lymphocytes, essential components for the body’s immune defense.
Oncologist Thiago Kaique, from Rede Mater Dei, highlighted that “acute myeloid leukemia is an aggressive form that compromises the body’s defense system and requires chemotherapy, immunotherapy or, in some cases, bone marrow transplant”.
What are the main signs and symptoms of leukemia
The most common signs of the disease include excessive tiredness, pale skin, persistent fever, recurring infections, spontaneous bruising and bleeding from the nose or gums.
Hematologist Joana Koury, member of the Acute Leukemia Committee of the Brazilian Association of Hematology, Hemotherapy and Cellular Therapy (ABHH), highlighted that “small bleeds, such as in the nose or gums, in addition to repeated infections, are warning symptoms that motivate the patient to seek medical help. The compromised marrow stops producing platelets and defense cells, which amplifies bleeding and infections.”
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Additionally, patients may experience unexplained weight loss, bone pain, and night sweats. In acute manifestations of leukemia, these symptoms usually appear within a few weeks.
How the new treatment fits into diagnosis and therapy
The diagnosis of acute myeloid leukemia usually begins with the detection of abnormalities in a blood count test. Confirming the disease requires bone marrow tests, such as a myelogram, in addition to genetic tests that are essential to identify specific mutations and guide the choice of the most appropriate treatment.
Joana Koury explained that “the karyotype and other molecular tests help predict the patient’s response to chemotherapy or identify a greater risk of relapse. This not only defines the subtype, but also directs the therapeutic strategy.”
Currently, patients diagnosed with leukemia have access to several therapeutic approaches, which are selected based on the subtype of the disease and individual genetic characteristics. These options include conventional chemotherapy, targeted therapies, immunotherapy, specific oral medications and bone marrow transplantation.
Action of venetoclax and azacitidine, medications approved by the SUS
Venetoclax is part of the group of targeted therapies, acting directly to inhibit proteins that are crucial for the survival of tumor cells. At the same time, azacitidine acts to inhibit the growth and replication of diseased cells in the body.
The combination of these two drugs has established itself as one of the main therapeutic options for patients with acute myeloid leukemia who cannot tolerate intensive chemotherapy. This situation is particularly common among elderly people and those with other associated health conditions, filling an important gap in the therapeutic arsenal for this vulnerable population.
Sabrina Brant, onco-hematologist at Hospital Sírio-Libanês in Brasília, commented: “In recent years, we have made significant advances that make it possible to create personalized strategies. In younger patients with certain genetic mutations, the chances of a cure can be substantially higher.”
The importance and risks of bone marrow transplantation
In certain cases, especially in younger patients or those at high risk of disease relapse, bone marrow transplantation remains one of the most relevant therapeutic interventions with curative potential.
This procedure involves destroying the affected bone marrow, using chemotherapy or radiotherapy, and subsequently replacing it with healthy stem cells from a compatible donor.
Breno Gusmão warned: “Even with 100% compatible donors, there is a risk of rejection. For this reason, the patient requires immunosuppressants for several months. It is a delicate balance between avoiding rejection and not making the body excessively vulnerable to infections.”
With the officialization of the ordinance, the combination of venetoclax and azacitidine is now formally included in the list of technologies offered by the SUS. This treatment is indicated for patients with newly diagnosed acute myeloid leukemia who are not eligible for intensive chemotherapy, and is expected to be available in public health services within the next six months.
