Intermediate Risk, Induction Therapy?

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Frequent Questions regarding AML

What is an Intermediate risk diagnosis?
Approximately 50% of patients with AML have no detectable cytogenetic abnormalities (chromosomal structure of the leukemic cell). Current methods categorize these patients as being at intermediate risk. Intermediate risk means that, post chemotherapy, there is no clear high or low risk for relapse. An intermediate risk means that a treatment decision may be based on incomplete data. It also means if given 3-4 weeks of induction therapy it may not work. If diagnosed as an intermediate risk it's crucial to be screened for FLT3 Mutations which can differentiate a patient and determine if more targeted therapies are appropriate.

What is induction therapy?
Chemotherapy is divided into two phases: induction and postremission (or consolidation) therapy. The goal of induction therapy is to achieve a complete remission by reducing the amount of leukemic cells to an undetectable level.

Why should I continue treatment once I'm in complete remission?
After induction therapy ideally leukemic cells will reach an undetectable level. An undetectable level is simply below what today's current diagnostic techniques are able to detect. In most patients leukemic cells are still present in patients in full remission but are in numbers too small to be detected. Because leukemia cells are most likely still present patients in complete remission need to continue some type of therapy. If they do not continue therapy almost all patients will eventually relapse. The goal of consolidation therapy is to achieve a cure.

What is a FLT3 Mutation?
A FLT3 Mutation is a genetic mutation in an individual. This genetic mutation may be screened for when diagnosed with AML. When your doctor screens for the FLT3 Mutation more accurate prognostic indicators can assist wtih treatment decisions for all AML patients. Some treatment options that might normally be avoided based on normal cytogenetic profiles might be considered when FLT3 status foretells a high risk for relapse after chemotherapy. Having the FLT3 mutation does not equate to having a poor cure rate. Clinical trials involving FLT3 inhibitors are being performed by several pharmaceutical companies. For inclusion in these trials, most require testing to confirm the presence of the FLT3 Mutation. Read more about screening for FLT3 Mutations.

What if I relapse?
The only proven potentially curative therapy is a stem cell transplant. Patients with relapsed AML who are not candidates for stem cell transplantion, or who have relapsed after a stem cell transplant, may be offered treatment in a clinical trial, as conventional treatment options are limited. Agents under investigation include cytotoxic drugs such as clofarabine as well as targeted therapies such as farnesyl transferase inhibitors, decitabine, and inhibitors of MDR1 (multidrug-resistance protein). Since treatment options for relapsed AML are so limited, another option which may be offered is palliative care.

Questions to Ask Your Doctor

General Questions

  • What type of AML do I have? What does it mean to have this variant of the disease?
  • Do you know how quickly it is likely to progress?
  • Can I enroll in a clinical trial? How would this affect the quality of my treatment?
  • What is the recommended treatment for my stage of AML?
  • If I don't have insurance coverage, what are my options?
  • Which center would be able to provide the best treatment for my leukemia?
  • Are there any other options besides a bone marrow transplant?
  • When should I start treatment?
  • If I have this treatment, what are my chances of survival?
  • If I have treatment, will my AML return?
  • What are the results of the cytogenetic testing?
  • What are the results of the immunophenotyping?
  • What can I do to lower my risk of infection during chemotherapy?
  • Can the leukemia spread once I am on chemotherapy?

After Induction Therapy

  • Are blasts present?
  • Do I have any infections?
  • What is my prognosis? Are there any lifestyle changes I can make to improve my prognosis?
  • Are blood counts returning to normal levels?
  • Has complete remission been achieved?
  • Why do I need more treatment after I achieve remission?

For Chemotherapy

  • What are the names of the drugs that will be used?
  • How many treatments will I need? Can I go home afterwards?
  • What will I feel like after my treatments? Work? Children?
  • What are the possible side effects of these treatments? Will my hair fall out? Will I be nauseous? Will I be exhausted? Will I get mouth sores?
  • Is there anything I can do to lessen the side effects?
  • If I am taking chemotherapy, can I eat all kinds of foods?
  • Will chemotherapy affect my sex life?
  • Will chemotherapy affect my chances of getting pregnant and having a normal baby? OR
  • Will chemotherapy affect my chances of fathering a child?