Acute myeloid leukemia (AML) is characterized by a rapidly-developing cancer in the myeloid line of blood cells, which is responsible for producing red blood cells, platelets and several types of white blood cells called granulocytes.
Because AML grows rapidly, it can quickly crowd out normal blood cells, leading to anemia, susceptibility to infections and uncontrolled bleeding.
Due to the aggressive nature of AML, this disease usually requires intensive treatment, which may include chemotherapy, radiation therapy, immunotherapy and stem cell transplantation.
The following represent symptoms typical for AML:
•Fever with or without an infection
•Frequent bruising or bleeds that do not clot
•Leukemia cutis (multiple lesions with a firm or rubbery consistency that may be pink, red, red-brown or blue-violet in color)
•Night sweats
•Pain in the bones or joints
•Pain or feeling of fullness below the ribs
•Petechiae (flat, pinpoint spots under the skin caused by bleeding)
•Shortness of breath
•Weakness or feeling tired
Listen in as Guido Marcucci, MD discusses AML, it's symptoms, diagnoses and treatments.
What You Should Know About Acute Myeloid Leukemia (AML)
Featured Speaker:
He is the Director of the Gehr Leukemia Center. His Primary Specialties are
Hematology/Oncology.
Guido Marcucci, MD
Guido Marcucci, MD is a Professor, Hematology & Hematopoietic Cell Transplantation.He is the Director of the Gehr Leukemia Center. His Primary Specialties are
Hematology/Oncology.
Transcription:
What You Should Know About Acute Myeloid Leukemia (AML)
Melanie Cole (Host): City of Hope physicians have created new treatment protocols for many types of leukemia, including some rare leukemias that have not been formerly classified. Today, we’re talking about acute myeloid leukemia with Dr. Guido Marcucci. He’s a professor in hematology and hematopoietic cell transplantation and the director of Gehr Leukemia Center at City of Hope. Welcome to the show, Dr. Marcucci. What is acute myeloid leukemia, and are there different types of leukemia we should be aware of?
Dr. Guido Marcucci (Guest): Acute myeloid leukemia is also known as AML. It’s a devastating disease. It basically is a form of cancer of the bone marrow that if left untreated leads basically to death of a patient through bone marrow failure. These patients do not have white count to fight infections. These patients does not have red cells to supply oxygen to organs such as heart, kidneys, liver, et cetera. These patients do not have platelets to prevent any bleeding. Infection and bleeding probably are the most important cause of death in patients that are left untreated or don’t respond to the treatment they receive.
Melanie: Why did you decide to specialize in this form of cancer?
Dr. Marcucci: Well, several reasons. In addition to some personal reasons, from a scientific standpoint, I would say that AML may be a prototype of cancer and how cancer develops and eventually persists after treatment. Basically, this is a form of cancer where we have relative success to primary cells from the patients through either blood draw or bone marrow aspirate. We can study directly these cancer cells that we call blasts over time, before treatment and sequential time point after treatment to understand how these malignant cells respond to change in response to the treatment we administer to the patient. In some way, we also understand that there are different types of change in genes that we call mutations that affect the different classes of genes and proteins, and together, we start to understand how they cooperate in producing what we call a leukemia phenotype. In other words, what we call a manifestation of the disease. Basically, they assess through these primary samples and the study of these primary samples and challenging these primary samples with investigation of drugs give us a very good idea of what we should do in clinical trials and in daily treatment of AML patients.
Melanie: Are there certain people that are more at risk for AML than others?
Dr. Marcucci: I will say yes. Generally speaking, AML is a relatively rare disease. We have frequency of about two people every hundred thousand, although when we consider also only older people, probably this frequency increased to about 13 to 14 patients for every hundred thousand people. We’ll say old age definitely is a risk factor. Aging is a risk factor. But more important here is that certain type of congenital or hereditary disease that impact the ability of the individual to having a normal hematopoietic function—in other words, be able to produce blood and the blood’s cellular elements. Most importantly, there is another risk population that is connected with the patient that received chemotherapy before, patient that has been cured from another type of cancer that they received some specific chemotherapy agent may develop in a very small but significant percentage, may develop AML within three to five years of the treatment.
Melanie: If someone is diagnosed, Dr. Marcucci, is it worth going for a second opinion?
Dr. Marcucci: Well, usually diagnosis of AML is something that is mostly an emergency. In other words, patients usually come to our attention with symptoms that need to be treated right away. Most of the people present with very high fever and infections, and usually they present also with sign of bleeding or potential severe bleeding in addition to other symptoms related to patient’s comorbidities. If the patient, for instance, has heart problems -- usually low red blood cells that we call anemia may cause chest pain or other dysfunction related to the comorbidity, et cetera. Generally speaking, they need immediate attention, but after the initial care, clearly it’s really important that the patients will be referred to tertiary centers or an expert in AML because the treatment of AML is complex in terms of chemotherapy that patients need to receive initially and the decision regarding how the treatment will continue later on, either with the chemotherapy alone or with hematopoietic stem cell transplantations. This is important because of many, many new drugs targeting very specific defect in AML, very specific genetic defect in AML in the blast, in the malignant cells of AML are emerging. These drugs are available only in those centers with specialized care for AML such as the City of Hope.
Melanie: Tell us a little bit about some of the treatment options. We don’t have a lot of time, Dr. Marcucci, but tell us a little bit about stem cell transplantation, and will those treatments affect daily activities? How tough are these kinds of treatments for AML?
Dr. Marcucci: AML is treated with high intensity chemotherapy with or without hematopoietic stem cell transplant once the patient has achieved complete remission with the chemotherapy alone. The truth is that unfortunately, AML is a very heterogeneous type disease. There are some patients that we can predict that will do well only with the chemotherapy. In some patients that instead we know that are going to relapse from their disease, if we use chemotherapy only for treatment and those patients are those that are candidate for hematopoietic stem cell transplant. Clearly, AML is a devastating disease for the patient, the family, and from a socioeconomic standpoint because the treatments are very long, may require up to six, eight months for completing all the treatments. Clearly, in those period, even a few months after that, the patient is not able to care for themselves, and clearly they need a lot of care in the hospital and both at home, and many of these patients are not able to return to work until they really complete all the treatments, including a stem cell transplant. Clearly, it’s a very complex type situation, but fortunately, we are making progress, and a good percentage of the patients are cured from a disease that until a few years ago was absolutely a death sentence.
Melanie: I am amazed that you said that, and thank you so much, Dr. Marcucci. In just the last minute or so, give the listeners your best hope if they are suffering from AML and why they should come to City of Hope for their care.
Dr. Marcucci: Well, City of Hope is an exceptional place with a long, long history of expertise and discoveries and invention of new treatments for AML and other hematologic malignancies. City of Hope is one of the best centers for hematologic stem cell transplantations, and clearly there is a lot going on here in terms of discovering and testing new drugs for AML. Hopefully, it will allow us not to cure only infection of patients with AML but all the patients with AML in the near future.
Melanie: Thank you so much. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening and have a great day.
What You Should Know About Acute Myeloid Leukemia (AML)
Melanie Cole (Host): City of Hope physicians have created new treatment protocols for many types of leukemia, including some rare leukemias that have not been formerly classified. Today, we’re talking about acute myeloid leukemia with Dr. Guido Marcucci. He’s a professor in hematology and hematopoietic cell transplantation and the director of Gehr Leukemia Center at City of Hope. Welcome to the show, Dr. Marcucci. What is acute myeloid leukemia, and are there different types of leukemia we should be aware of?
Dr. Guido Marcucci (Guest): Acute myeloid leukemia is also known as AML. It’s a devastating disease. It basically is a form of cancer of the bone marrow that if left untreated leads basically to death of a patient through bone marrow failure. These patients do not have white count to fight infections. These patients does not have red cells to supply oxygen to organs such as heart, kidneys, liver, et cetera. These patients do not have platelets to prevent any bleeding. Infection and bleeding probably are the most important cause of death in patients that are left untreated or don’t respond to the treatment they receive.
Melanie: Why did you decide to specialize in this form of cancer?
Dr. Marcucci: Well, several reasons. In addition to some personal reasons, from a scientific standpoint, I would say that AML may be a prototype of cancer and how cancer develops and eventually persists after treatment. Basically, this is a form of cancer where we have relative success to primary cells from the patients through either blood draw or bone marrow aspirate. We can study directly these cancer cells that we call blasts over time, before treatment and sequential time point after treatment to understand how these malignant cells respond to change in response to the treatment we administer to the patient. In some way, we also understand that there are different types of change in genes that we call mutations that affect the different classes of genes and proteins, and together, we start to understand how they cooperate in producing what we call a leukemia phenotype. In other words, what we call a manifestation of the disease. Basically, they assess through these primary samples and the study of these primary samples and challenging these primary samples with investigation of drugs give us a very good idea of what we should do in clinical trials and in daily treatment of AML patients.
Melanie: Are there certain people that are more at risk for AML than others?
Dr. Marcucci: I will say yes. Generally speaking, AML is a relatively rare disease. We have frequency of about two people every hundred thousand, although when we consider also only older people, probably this frequency increased to about 13 to 14 patients for every hundred thousand people. We’ll say old age definitely is a risk factor. Aging is a risk factor. But more important here is that certain type of congenital or hereditary disease that impact the ability of the individual to having a normal hematopoietic function—in other words, be able to produce blood and the blood’s cellular elements. Most importantly, there is another risk population that is connected with the patient that received chemotherapy before, patient that has been cured from another type of cancer that they received some specific chemotherapy agent may develop in a very small but significant percentage, may develop AML within three to five years of the treatment.
Melanie: If someone is diagnosed, Dr. Marcucci, is it worth going for a second opinion?
Dr. Marcucci: Well, usually diagnosis of AML is something that is mostly an emergency. In other words, patients usually come to our attention with symptoms that need to be treated right away. Most of the people present with very high fever and infections, and usually they present also with sign of bleeding or potential severe bleeding in addition to other symptoms related to patient’s comorbidities. If the patient, for instance, has heart problems -- usually low red blood cells that we call anemia may cause chest pain or other dysfunction related to the comorbidity, et cetera. Generally speaking, they need immediate attention, but after the initial care, clearly it’s really important that the patients will be referred to tertiary centers or an expert in AML because the treatment of AML is complex in terms of chemotherapy that patients need to receive initially and the decision regarding how the treatment will continue later on, either with the chemotherapy alone or with hematopoietic stem cell transplantations. This is important because of many, many new drugs targeting very specific defect in AML, very specific genetic defect in AML in the blast, in the malignant cells of AML are emerging. These drugs are available only in those centers with specialized care for AML such as the City of Hope.
Melanie: Tell us a little bit about some of the treatment options. We don’t have a lot of time, Dr. Marcucci, but tell us a little bit about stem cell transplantation, and will those treatments affect daily activities? How tough are these kinds of treatments for AML?
Dr. Marcucci: AML is treated with high intensity chemotherapy with or without hematopoietic stem cell transplant once the patient has achieved complete remission with the chemotherapy alone. The truth is that unfortunately, AML is a very heterogeneous type disease. There are some patients that we can predict that will do well only with the chemotherapy. In some patients that instead we know that are going to relapse from their disease, if we use chemotherapy only for treatment and those patients are those that are candidate for hematopoietic stem cell transplant. Clearly, AML is a devastating disease for the patient, the family, and from a socioeconomic standpoint because the treatments are very long, may require up to six, eight months for completing all the treatments. Clearly, in those period, even a few months after that, the patient is not able to care for themselves, and clearly they need a lot of care in the hospital and both at home, and many of these patients are not able to return to work until they really complete all the treatments, including a stem cell transplant. Clearly, it’s a very complex type situation, but fortunately, we are making progress, and a good percentage of the patients are cured from a disease that until a few years ago was absolutely a death sentence.
Melanie: I am amazed that you said that, and thank you so much, Dr. Marcucci. In just the last minute or so, give the listeners your best hope if they are suffering from AML and why they should come to City of Hope for their care.
Dr. Marcucci: Well, City of Hope is an exceptional place with a long, long history of expertise and discoveries and invention of new treatments for AML and other hematologic malignancies. City of Hope is one of the best centers for hematologic stem cell transplantations, and clearly there is a lot going on here in terms of discovering and testing new drugs for AML. Hopefully, it will allow us not to cure only infection of patients with AML but all the patients with AML in the near future.
Melanie: Thank you so much. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening and have a great day.