Acute Myeloid Leukemia
Acute Myeloid Leukemia (AML) is an aggressive cancer that originates from the myeloid cells of the bone marrow, which interfere with normal blood production. This rapid accumulation of abnormal cells requires timely diagnosis and treatment. Below, we break down the available treatment options for adult AML, as outlined by the National Cancer Institute.
Diagnosis and Classification of AML
AML is diagnosed through:
- Complete Blood Count (CBC): Evaluates the number and types of blood cells.
- Bone Marrow Biopsy: Confirms the presence of leukemia cells.
- Cytogenetic and Molecular Testing: Identifies specific genetic mutations, such as FLT3, NPM1, and IDH1, that impact prognosis and treatment decisions.
The World Health Organization (WHO) classifies AML based on genetic mutations and cell characteristics, providing valuable information for choosing appropriate treatment strategies
Comprehensive Cancer Information
Comprehensive Cancer Information.
Treatment Options for Adult AML
1. Induction Chemotherapy
- Goal: Achieve remission by killing leukemia cells in the blood and bone marrow.
- Standard Regimen: “7+3” protocol (7 days of cytarabine with 3 days of daunorubicin).
Patients are monitored for remission after induction therapy and may require additional cycles to achieve complete remission.
2. Consolidation Therapy
- Purpose: Eliminate remaining leukemia cells and prevent relapse.
- High-Dose Chemotherapy: Common for younger, healthier patients.
- Stem Cell Transplantation: Recommended for high-risk or relapsed patients to improve long-term outcomes.
Targeted Therapies
Targeted therapies offer more personalized treatment based on genetic mutations:
- FLT3 Inhibitors (e.g., Midostaurin): Used for AML with FLT3 mutations.
- IDH1/2 Inhibitors (e.g., Enasidenib): Effective for patients with IDH mutations.
- Venetoclax: Often combined with low-dose chemotherapy, especially for older patients unfit for intensive treatmentsComprehensive Cancer Information.
Stem Cell Transplantation
- Allogeneic Hematopoietic Stem Cell Transplantation (HSCT): Involves replacing damaged bone marrow with healthy donor cells.
This approach offers the potential for a cure but carries risks, including graft-versus-host disease (GVHD) and infections. It is typically used for patients with high-risk AML or those who relapse after initial treatmentComprehensive Cancer Information.
Liposomal Chemotherapy: Vyxeos
Vyxeos is a combination of cytarabine and daunorubicin encapsulated in a liposome. This formulation delivers the drugs more efficiently, enhancing the therapeutic effect with fewer side effects. It is approved for high-risk AML, such as AML with myelodysplasia-related changes (AML-MRC)
Comprehensive Cancer Information.
Managing Relapsed or Refractory AML
In cases where AML recurs, patients may benefit from:
- Targeted therapies like FLT3 or IDH inhibitors.
- New clinical trials testing experimental drugs and combinations.
- Stem cell transplantation if feasible.
Conclusion
AML treatment is complex and varies based on individual factors such as genetic mutations and the patient’s overall health. Advances in targeted therapies, improved chemotherapy protocols, and innovative treatments like Vyxeos have significantly improved outcomes. Patients are encouraged to explore clinical trials and seek second opinions to find the most suitable treatment path.
To learn more, visit the detailed guide by the National Cancer Institute.
