Acute Myeloid Leukemia (AML) is a form of cancer that affects the blood and bone marrow and grows quite rapidly. It begins when immature white blood cells known as myeloblasts start to undergo unchecked proliferation which subsequently leads to the suppression of normal cell production.
Dr Amrita Ramaswami, Principal consultant, Dept. of Hemato-oncology and stem cell transplantation, Max Superspecialty Hospital, Shalimarbagh, says, “In contrast to chronic forms of leukemia that progress slowly, AML has the potential to worsen in days or weeks—underscoring the importance of early detection and prompt treatment.”
What Makes AML So Aggressive?
Dr Amrita says, “Unlike some cancers that grow slowly over time, AML tends to grow swiftly, often catching patients and families off guard. This rapid progression may be linked to how AML interferes with the body’s natural blood-making process, known as hematopoiesis.”
“Bone marrow becomes packed with excess tumor cells called myeloblasts, leading to insufficient production of normal red blood cells, white blood cells, and platelets. These processes lead to fatigue, increased susceptibility to infections and bruising, and if not treated, may often advance rapidly towards severe life-threatening complications like sepsis and intracranial bleeding,” she further reveals.
Moreover, each patient diagnosed with AML does not present homogenous disease characteristics because this malignancy is particularly heterogeneous. There are some mutations at the molecular level like FLT3, NPM1 or IDH1 that could determine the particular disease course while also influencing the treatment response. This adds further complexity and challenge to the situation since there would no universal treatment method befitting all patients.
What Methods are Currently Used to Treat AML?
Dr Amrita says, “In the past, patients with AML were primarily managed with aggressive chemotherapy followed by bone marrow transplant in suitable candidates. Although this continues to be the mainstay approach for many patients, it may not be appropriate for all patients, particularly elderly individuals or those with comorbid conditions who constitute the majority of patients diagnosed with the disease.”
“In recent years, there has been a major therapeutic shift in the management of AML. Specifically, the development of newer types of therapies that aim at treating specific genetic alterations present in the cancer cells known as targeted therapies are improving disease management and also mitigating toxicities,” says Dr Amrita.
Likewise, for persons harboring the IDH1 mutation, Ivosidenib targets one such mutation making it easier for more precise therapy than previously available. These therapies tend to minimise damage to important normal tissues which would otherwise be seen with older style chemotherapy drugs.
Dr Amrita says, “Although these approaches do not provide a cure, they can be beneficial either alone or in combination with other agents, in improving the survival and providing better functioning in daily activities particularly when integrated into routine care regimens customised according to patient’s genetic makeup.” The future of AML treatment would likely be rational combinations of targeted therapies with low dose conventional chemotherapy in most subtypes of AML.
Advances in Medicine: The Developments of AML Treatments
New targets and drug combinations are continually being investigated with the objective of refining the efficiency and reducing the toxicity of AML treatments. While considerable strides have been made towards treating the disease better, acute myeloid leukemia continues to present challenges requiring precise assessment and prompt treatment from a seasoned clinician.
Dr Amrita concludes, “In case you or any of your loved ones has been diagnosed with acute myeloid leukemia, consult a specialist in hematology/hemato-oncology. A medical professional would be able to determine the best approach tailored for you after thorough evaluation.”