Spotlight on Acute Myeloid Leukemia

September was Blood Cancer Awareness month, a time for survivors, patient advocates and supporters to shine a light on this challenging cancer.

Chances are that you may not know that much about blood cancer unless it has impacted you or someone you love.  Maybe you know that blood cancer includes lymphoma, myeloma, Hodgkin’s lymphoma, and leukemia. It’s even less likely that you’d know about the different types of leukemia and very unlikely that you’d know about acute myeloid leukemia (AML), even though it is the second most common type of leukemia in adults.

Fortunately, treatment has brought hope to the fore.

What is AML?

AML is a blood cancer. Doctors call AML “acute” because the condition usually starts suddenly; “myeloid” relates to the type of cell it affects, and “leukemia” refers to cancer of the bone marrow and blood cells.

This condition damages the DNA of developing stem cells in the bone marrow. The damaged cells become leukemic cells that multiply into leukemic blasts instead of maturing into red or white blood cells, or platelets. It is this overproduction of leukemic blasts that interferes with the normal production of healthy blood cells. The blasts also grow and survive better than the normal cells. Together, this means that the number of healthy blood cells produced by the body is lower than normal.

Who gets AML?

AML is generally considered a disease of older adults.  It is uncommon in those under 45, and was diagnosed in approximately 1,100 Canadians in 2016. This might increase, as the population in Canada ages.

What are the symptoms of AML?

Blood cancers share some common signs and symptoms. Some people may not have any symptoms until the disease is advanced, or the symptoms may be mistaken for a severe cold or flu.  Symptoms can include fever, frequent infections, loss of appetite, fatigue, breathlessness, and weight loss among others.

What is secondary AML?

AML has many different subtypes. One of the sub-types is secondary AML which includes therapeutic related AML (T-AML), caused by prior chemotherapy or radiation and myelodysplasia-related AML (AML-MRC), which occurs when a person has abnormal bone marrow cells due to a prior blood disorder. These generally put patients at a higher risk of poorer outcomes.

What is the prognosis of secondary AML?

For most cancers, the stage and grade of a cancer tumour can tell the healthcare team a lot about the prognosis, as well as guide the treatment plan. However, AML cannot be staged like other forms of cancer, and prognosis depends largely on other factors like the subtype, determined by lab tests. The 5-year net survival for AML is only 21%. However, while the prognosis of AML is sobering, the good news is that there are treatments available.

How is AML treated?

Dr. Brian Leber, Professor, McMaster University and clinical hematologist, notes, “Knowing your subtype can be very important not just for understanding the expected outcome but so that your healthcare team can make the best choices about your treatment path.”

Treatment consists of a variety of anti-cancer drugs including chemotherapy and where possible, stem cell transplant.

Staying up to date on research and treatments can help you to make informed decisions with your health care team.

How do those facing a secondary AML diagnosis cope?

There is no one way to cope with a difficult diagnosis like high-risk AML.  Diagnosed individuals may experience a wide range of emotions, as will their loved ones.  Support from loved ones, others who are on the same journey or mental health professionals can be key.  Those who have experienced very difficult diagnoses sometimes find unforeseen gifts such as greater appreciation for the moments and people in their lives.

Your healthcare team should be part of your support system, helping you to educate yourself and supporting informed decisions.  While it can feel overwhelming at times, particularly in the initial stages of diagnosis, being active in your care can provide the reassurance that the best available options for you are being considered and give a sense of control.  Trustworthy organizations like the Leukemia and Lymphoma Society of Canada or the Canadian Cancer Society can provide a wealth of information, resources and support.