Acute Myeloid Leukemia (AML) is a serious form of blood cancer that originates in the bone marrow. This condition is characterized by the rapid, uncontrolled growth of abnormal myeloid cells, a type of white blood cell, which then interfere with the production of healthy blood components. While an AML diagnosis can be challenging, ongoing advancements in understanding and treating this disease offer hope for achieving remission and improving long-term survival.
Understanding Acute Myeloid Leukemia
AML develops when immature myeloid cells, called blasts, proliferate excessively in the bone marrow and blood, preventing the normal development of red blood cells, platelets, and healthy white blood cells. This disruption leads to a range of symptoms. Individuals might experience persistent fatigue, shortness of breath due to a low red blood cell count, or easy bruising and bleeding from a lack of platelets. Fevers, frequent infections, and unexplained weight loss are also common indicators, sometimes accompanied by bone or joint pain. Sometimes, the abnormal cells can infiltrate other tissues, leading to symptoms like swollen gums or skin lesions.
Standard Treatment Pathways for AML
Treating newly diagnosed AML involves a multi-phase approach, beginning with intensive chemotherapy to achieve remission. The initial phase, known as induction therapy, aims to eliminate leukemia cells from the blood and bone marrow, bringing the disease to an undetectable level. A common regimen for induction therapy is the “7+3” protocol, which involves continuous intravenous cytarabine for seven days combined with an anthracycline, such as daunorubicin or idarubicin, administered for three days. For patients with specific genetic mutations, such as FLT3, targeted therapies like midostaurin or quizartinib may be added to this chemotherapy regimen to enhance effectiveness.
After achieving remission, the second phase, called consolidation therapy, is initiated to eradicate any remaining leukemia cells that might not have been detected during induction. This phase is important for preventing relapse and involves additional cycles of chemotherapy, potentially at higher doses, or an allogeneic stem cell transplant. An allogeneic stem cell transplant, which uses healthy stem cells from a donor, is considered for patients with higher-risk disease or those who can tolerate the intensive procedure. For older patients or those with other health conditions, less intensive treatments may combine low-dose chemotherapy agents like azacitidine or decitabine with targeted drugs such as venetoclax.
Strategies for Relapsed or Refractory AML
When AML returns after a period of remission, it is termed “relapsed” AML, while “refractory” AML refers to the disease that does not respond to initial treatment. In these situations, the primary goal is to reduce the leukemia burden, often to enable an allogeneic hematopoietic stem cell transplantation (HSCT), which offers the best chance of a cure. Salvage chemotherapy regimens, involving high-dose cytarabine combined with other agents like mitoxantrone or etoposide, are used to achieve a second remission.
Targeted therapies play an important role in relapsed or refractory AML, especially for patients with specific genetic alterations. For instance, gilteritinib is approved for patients with relapsed AML harboring a FLT3 mutation, while drugs like ivosidenib or enasidenib target IDH1 or IDH2 mutations, respectively. Novel therapies, such as menin inhibitors, are also being explored in clinical trials for patients with NPM1 mutations or KMT2A rearrangements. For individuals who may not be strong enough for intensive chemotherapy, less aggressive approaches, including combinations of azacitidine or decitabine with venetoclax, are considered.
Life After AML Treatment
Completing AML treatment marks a milestone, though the journey toward full recovery can continue for several months, or even up to a year. Regular follow-up appointments are a necessary part of post-treatment care, starting monthly and gradually decreasing in frequency over several years. These visits involve physical examinations and blood tests or bone marrow exams to monitor for any signs of relapse and to assess for potential long-term side effects from treatment.
Beyond medical monitoring, life after AML treatment involves adjusting to a new normal. Many individuals experience a mix of relief and anxiety, including concerns about the leukemia returning or coping with lasting physical and emotional side effects. Physical activity can help rebuild fitness and improve overall well-being, while psychological support, such as counseling, can assist in processing the experience and managing feelings of sadness or anxiety. Developing a survivorship care plan with the medical team can provide a structured approach to ongoing health management, including recommendations for future tests and lifestyle adjustments.