Due to the aggressive nature of acute myeloid leukemia (AML), administering prompt and efficient treatment is critical for patients’ survival. Induction chemotherapy is most often used as initial treatment for AML to induce a remission, however, only 20-25% of AML patients will be cured by chemotherapy alone. For the majority of AML patients, blood or bone marrow transplant (BMT) following chemotherapy offers the best potential for cure. Given the rapid progression of AML for eligible patients, it is often best to proceed with the BMT without delay.
Using cytogenetic analysis and molecular markers in conjunction with bone marrow biopsies, physicians with University of Minnesota Cancer Care are able to determine the disease severity for individual AML patients as well as predict their response to induction chemotherapy. Patients are recognized as having either standard or high-risk disease based on the presence certain genetic abnormalities in their bone marrow and their overall general health. Those in standard risk groups may require chemotherapy alone to control their leukemia while those with higher risk features will require BMT after they achieve a remission.
To prevent delays in treatment, AML patients should have prompt tissue typing and active efforts to identify a related or unrelated matched donor, while they undergo induction chemotherapy. Following chemotherapy, patients are evaluated to determine their suitability for transplant based on the achievement of remission and their overall health. When a bone marrow biopsy verify that the patient is in remission and pre-transplant workup determine adequate organ functions, BMT with the best available can then proceed without delay. Since transplant complications are more frequent in older patients, they are more carefully evaluated for their performance status, their capacity for activity, and a frailty index, a more objective test of a patient’s strength and stamina. These tests have shown great value in predicting BMT complications and outcomes, thereby affording individual AML patients with the appropriate treatment plan based on their disease severity and overall health. Currently, we offer allogeneic transplantation for suitable individuals up to age 75.
Through Masonic Cancer Center, University of Minnesota, we continue to research new treatments with novel drugs and cellular therapies for patients who cannot achieve remission after standard therapies, so more patients can reach transplantation and have a chance for cure.
-Contributed by Celalttin Ustun, MD
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