Acute Myeloid Leukemia (AML) is a fairly rare cancer in adults. Most patients first discover their disease when they have recurrent infections, bleeding or extreme fatigue. As the bone marrow fills up with abnormal cancer cells (known as blasts), the normal bone marrow cells decrease in number. Thus patients may have low numbers of red blood cells (the cells that carry oxygen and nutrients), low numbers of platelets (the cells that help with clotting), and low numbers of normal white blood cells (the cells that fight infections). Untreated AML can lead to rapid illness.

The diagnosis is confirmed by a test known as a bone marrow biopsy and aspirate. Under the microscope the leukemia can be subdivided into 7 different types. In addition, the chromosomes (genes) are examined.

Acute myeloid leukemias can be divided into low risk, intermediate risk, and high-risk diseases. Low risk features include AML-M2 with translocation 8:21 or AML-4eo with inversion 16. Intermediate risk features include AML-M3 with 15:17 and AML with normal chromosomes.

Treatment of AML consists of aggressive chemotherapy (called induction therapy) designed to place the patient in remission. This treatment frequently requires a month-long hospital stay. If successful, induction therapy is followed by additional treatments (known as consolidation or intensification) to keep the patient in remission (and hopefully result in cure).

Transplantation Therapy in AML

Transplantation therapy is frequently used in the treatment of AML. Transplant is the only treatment that is able to cure patients with disease that is refractory to initial therapy (that is not responding) or has relapsed following a prior remission. In these settings transplantation therapy must be rapidly explored. In patients without HLA-matched brother/sister donors, a search of the National Marrow Donor Program for an unrelated donor may be appropriate. BR>

For patients in first remission, the use of transplantation therapy as initial treatment is based on a careful assessment of the risks of treatment and the potential benefits. In the largest prospective randomized study published to date, 569 patients with AML in first complete remission were treated with either allogeneic transplantation, autologous transplantation, or conventional dose chemotherapy. The disease-free survivals at 4-years was 54%, 49%, and 30% respectively. (Zittoun RA et al: New Engl J Medicine 1995; 332:217).

The Adult Stem Cell- Bone Marrow Transplant Program of Hackensack University Medical Center has active transplant treatment protocols for Acute Myelogenous Leukemia. For more information on this treatment or to schedule an appointment call (201) 996-5849.

ALLOGENEIC TRANSPLANT OPTIONS

For patients with Tissue-matched (HLA-matched) brother/sister bone marrow donors allogeneic transplantation treatment protocols may be appropriate. One trial uses high-dose cyclophosphamide combined with either total body irradiation or high-dose busulfan. Following this aggressive conditioning therapy, bone marrow (or peripheral blood stem cells) from an HLA-matched donor is infused. Graft-versus-host disease prevention is accomplished with combinations of tacrolimus and methotrexate. This very aggressive curative treatment requires a one-month hospitalization.

UNRELATED TRANSPLANT TREATMENT OPTIONS

For patients lacking a family member marrow donor, the Hackensack University Medical Center Transplant Programs are participating in several unrelated transplant protocols.

The National Marrow Donor Program has enlisted over 3 million volunteer bone marrow donors. If an HLA matched unrelated donor can be located, a transplant using high-dose cyclophosphamide and total body irradiation can be performed.

Hackensack University Medical Center is also participating in a multicenter trial evaluating the use of expanded Cord Blood Cells in the treatment of cancers and blood diseases. This trial also extends the treatment options for patients without HLA Matched relative donors. For more information click here and also review ex-vivo expansion in the stem cell laboratory section.

AUTOLOGOUS TRANSPLANT OPTIONS

High-dose treatments with cyclophosphamide and either busulfan or total body irradiation can also be offered to patients who use their own marrow (or peripheral blood stem cells) as a source of transplantation stem cells. Post transplantation interleukin-2 infusions may also be used to reduce recurrence rates. For more information on autologous transplant options for AML call (201) 996-5849.

In addition to the above transplantation treatments, the physicians at the Northern New Jersey Cancer Center are experienced in the diagnosis and treatment of this disease. All forms of standard dose treatment including initial and relapse therapies are available. For more information call (201) 996-5900. Active research studies include a trial of PSC-833 in combination with standard chemotherapy for patients with relapsed or refractory disease.