Understanding AML

I've often heard that people enter our lives for different reasons. We don't always know why at the time, but at some point it becomes clear. It's become quite clear to me why a woman named Aimee is in my life - she is also the wife of an Air Force pilot and we met when our husbands worked together in Florida. Her husband was diagnosed with AML in November. She has been incredibly gracious and generous with her knowledge of the disease since dad's diagnosis. I'm so grateful.

Aimee recently sent me a copy of a talk by a world renowned researcher on topic of AML. Dr. Elihu Etsey spoke to the Leukemia & Lymphoma Society about "Understanding AML: From Diagnosis to Treatment." The best part is that much of the speech was in plain English making it easy to read and actually understand. I've copied some of the most helpful parts below.

Explaining AML

In the normal bone marrow there are immature cells that mature to form functional red blood cells and platelets and neutrophils. And these cells all have distinct roles: the red cells to carry oxygen and the neutrophils to prevent infection and the platelets to prevent bleeding. And without the bone marrow the number of these cells would rapidly dwindle to very low numbers.

In AML the normal AML immature cells (“blasts”) undergo transformation, becoming dysfunctional. As a result they are incapable of maturing.The abnormal blasts also prevent maturation of the normal blasts. The result is bone marrow failure and low blood counts. The symptoms of AML result from these low counts, particularly low numbers of red cells, which is called anemia. As a result of the anemia the patient feels tired, they’re weak, they have trouble going up stairs, etc. And they go to see the doctor and after a while of saying it’s probably something that will get better, it doesn’t and that leads to a blood count, which is found to be abnormal, leading to a bone marrow.

And the diagnosis of AML is based on seeing an increased number of immature cells in the bone marrow. This results from the transformation we described above and the inability of abnormal blasts to mature. As a result they accumulate in the bone marrow. And so there are increased numbers of immature cells when you do the bone marrow and this is the hallmark of AML. Because blasts are not difficult to recognize, the diagnosis is almost always correct when we see people referred from outside physicians.

On Treatment

The standard treatment in the United States for 35 years has been what’s called 3 plus 7 or 7 plus 3. And this refers to three days of an anthracycline, which is generally daunorubicin or idarubicin (with probably very few differences between them) and seven days of a drug that’s called Ara-C (also called cytarabine), and because the 3 plus 7 combination has been used so long there’s a lot known about how it performs.

The goal of giving the 3 plus 7 is to get the patient into remission. And the value of being in remission is that in general the people who are cured of this disease (because the disease is curable) are those who get a remission. And it’s very, very, very unlikely that the patient would be cured if they don’t get a remission. So the first step is to get a remission and, as I said, it’s usually accomplished with the 3 plus 7.