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November 10th, 2010
02:27 PM ET

Are there any treatments for acute myelogenous leukemia?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesday, it's Dr. Otis Brawley, a chief medical officer for the American Cancer Society.

Question asked by Brian Bauman of Columbus, Ohio:

Are there any treatments for acute myelogenous leukemia?

Expert answer:

Acute myelogenous leukemia is a series of diseases involving the white blood cells. These are the cells that fight infection. A number of genetic markers are used to categorize AML into several diseases.

Common to all AMLs is the fact that the bone marrow produces these cells, but they fail to fully mature. Patients commonly have lots of dysfunctional, not fully developed, white cells in their blood. The inability of these white cells to fight infection and the crowding out and decreased production of other blood cells cause complications.

The AMLs are different from other forms of leukemia in the age of the population affected, the standard treatments used and the chances of cure. The median age for patients who develop AML is about 64, meaning half are over the age of 65 years. Some leukemias, such as acute lymphocytic leukemia in children, have very high cure rates.

AML has a much poorer prognosis, especially for older patients. The median survival for patients over 60 is two months. The two-year overall survival is about 6 to 8 percent.

Treatments for AML are harsh. Younger patients tend to tolerate them better. Among AML patients over age 60, treatment is often limited by other co-morbid diseases such as hypertension, diabetes, or kidney or cardiovascular disease. Studies show that nearly a quarter of patients over 60 are not offered aggressive therapy aimed at long-term remission because of concerns about co-morbid disease.

Most published research on aggressively treated older patients with newly diagnosed AML has noted complete remission rates between 40 and 60 percent. This initial therapy is called induction. There are several induction regimens, but the most commonly used include two drugs: daunorubicin and cytarabine. Those who achieve complete remission need to get ongoing maintenance chemotherapy.

The aim of post-remission maintenance therapy is to destroy leukemia cells that survived induction chemotherapy but are undetectable. The preferred therapy for many with AML is stem cell transplant.

Very high doses of chemotherapy are given. The doses are so high that the blood-producing bone marrow is destroyed. Stem cells taken from a donor are then reinfused into the patient. These are cells that are early precursors of bone marrow and reimplant in the patient's bone marrow and start producing blood cells (red cells, white cells and platelets).

Note that some people often confuse stem cell transplants with fetal stem cell therapy. They are not related.

In a small number of patients, a stem cell transplant can be curative, but the therapy can also be fatal, especially in older patients. Consolidation chemotherapy is a less intensive post-remission maintenance therapy than a stem cell transplant. It is more commonly done in elderly patients. It has a lower early mortality rate but is less effective. Approximately 10 percent of AML patients over age 60 are alive five years after diagnosis.

The drug Mylotarg, generic name Gemtuzumab ozogamicin, was FDA-approved for post-remission treatment of AML in patients over age 60 several years ago. After post-approval evaluation, the drug was withdrawn in June 2010 as ineffective.

Participation in a clinical trial aimed at finding a better treatment is always a good option for patients who qualify. It is especially good when the prognosis with standard treatment is poor. Participants are getting a standard treatment or a new treatment that a number of experts have looked at and decided is reasonable.

You can think of this as not a second or third opinion, but a more powerful consensus of a number of experts. It is also of note that studies show that doctors who participate in clinical trials give better, more state-of-the-art therapy to all their patients than doctors who do not participate in clinical trials.

There are two very good sources for finding cancer clinical trials in the U.S. One is sponsored by the American Cancer Society (my employer) and the other by the National Cancer Institute.

The American Cancer Society Clinical Trials Matching Service is a free, confidential program that helps patients, their families and health care workers find cancer clinical trials most appropriate to a patient's medical and personal situation. It can be reached by phone at 1-800-303-5691 or the service's website.

The National Cancer Institute service is accessible at 1-800-4-CANCER or its website.


soundoff (12 Responses)
  1. Jay Kay

    I was diagnosed with AML when I was 27 years old. It's been almost 17 years since my chemo treatments and subsequent bone marrow transplant. All this done at the University of Minnesota. It's the place to go to if you have AML.

    November 10, 2010 at 17:09 | Report abuse | Reply
  2. I.V.Lishman

    I am now aproaching 81yrs old and am in my fifth year of remission from AML. I was lucky in responding well to standard chemotherapy and had very few side effects, so I was able to read extensively while in hospital for those 4 months! I think it helped to walk around the hospital pushing my IV drip stand in the early hours of the morning when there were no crowds.

    November 10, 2010 at 17:59 | Report abuse | Reply
    • angie raines

      who was your dr? my dr. says i am to old for treatment

      December 13, 2010 at 20:46 | Report abuse |
  3. P. Branch

    I was diagnosed with AML in December of 2007 at age 54 and after induction chemo therapy at Regions hospital in St. Paul MN I received my transplant from the University of Minnesota Fairview Hospital in Feb of 2008. I was also treated with full body ablative radiation before my transplant. All very grueling and painful. I returned to work part-time in August of 2008 and it took me a year to get back full time. I had a flair of GVHD in Sept of 2008 and was on immune system suppressant drugs until last week. This week I also returned to my volunteer firefighter job in the community where I live. I am amazed at what modern medicine can do, and I had a lot of support from family and friends. The best advice I can give is being your own best advocate, ask lots of questions even if they bother the doctor or nurse and staying active. I will also say both hospitals I was in have some very dedicated and compassionate people and that helped immensely.

    November 10, 2010 at 19:08 | Report abuse | Reply
  4. Eric McLean

    I was diagnosed at age 19 and have now survived AML three separate times (two relapses). I am now 26 and going strong about 1 year in remission. I've had two stem cell transplants. I've received a large number of chemotherapies and also had Mylotarg.

    This article is one of the best informative articles I've read about AML that is written on a level that anyone can understand. It took me years to learn all of the intricacies about AML, many of which could have been learned in the few minutes reading this.

    Well written and thank you!

    Eric

    November 10, 2010 at 20:53 | Report abuse | Reply
    • Diane D.

      Eric, that is encouraging. My son, now 22, has AML, was diagnosed in Feb. 2009, had a stem cell transplant in June 2009, returned to college in Jan. 2010 but relapsed in April 2010. He was able to get into remission this summer and we are using a special protocol to find a donor, based on a retrospective study by Dr. Miller at the U. Minnesota which found that by selecting a donor based on a specific genetic configuration, the relapse rate was decreased significantly. They are now getting ready to do a nationwide clinical study. We have just found a donor with the specific genetic configuration and hope that it will give our son a chance at a future. It is encouraging to hear that someone is doing well after a second transplant. What kind of AML did you have? Have you relapsed since your 2nd transplant? Do you have GVHD? And what type of transplant did you have (unmatched donor or sibling?)

      November 10, 2010 at 23:07 | Report abuse |
  5. Kathleen

    Love, love, love to hear your personal success stories. My mom died of AML in 1977. She was 29 years old. It is wonderful to hear how things have improved.

    My thoughts and prayers are with you all as you fight the fight.

    November 11, 2010 at 01:39 | Report abuse | Reply
  6. AB

    not to change the subject, but my daughter died of ALL. everyone keeps saying it has such a high cure rate, but then when you mention this there alot of MD dancing , like oh well it could be this , it could be that etc. let me ask this . if a kid goes in remission , is there ever a reason not to give them a maintenace program?

    November 11, 2010 at 14:36 | Report abuse | Reply
  7. Jodi Wolin

    Can anyone tell me if losing weight fast means there is no chance of slowing down the prognosis? Please advise. Very upset!

    December 5, 2010 at 07:53 | Report abuse | Reply
  8. angie raines

    i am 77 by the way

    December 13, 2010 at 20:48 | Report abuse | Reply
  9. Jennie

    My father will be 64 in March -2011 He is a retired Vietnam Vet and has PTSD along with congested heart failer. In November of 2010 my family was told that my father has AML and there is not much they can do for him, but give him small amounts of chemo do to is Heart .We where just told after the holidays that the chemo is not working that my father will have 6 months to a year to live. If anyone knows of anything that can help my father please share thanks

    January 12, 2011 at 12:50 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.