Acute Myeloid Leukemia
Acute myeloid leukemia (AML) is the most common type of acute leukemia among adults, with >19,500 new cases estimated in 2018 in the US alone. According to the NIH, AML accounts for 1.1% of all new cancer cases in the US. The disease typically affects males more than females, and more commonly occurs in older adults. The NIH reports that that 27.4% of people diagnosed with AML survive for 5 years or more (based on data from SEER 18 2008-2014). Since the early 1990s, AML incidence rates have increased – for which many reasons are speculated.
As with many hematological malignancies, the exact cause of AML is unknown; however, a variety of risk factors have been identified. These include prior chemotherapy or radiotherapy, exposure to benzene, tobacco use, and myelodysplastic syndrome. As a highlight heterogenous disease, the identification of recurrent mutations, including FLT3-ITD, NMP1 and CEBPA, has improved the risk stratification of patients and aided in treatment decision making.
The backbone of AML therapy is a combination of cytarabine and anthracycline based chemotherapy regimens, with allogeneic stem cell transplant for eligible patients. However, elderly patients are often not able to tolerate intensive treatments such as these. Exciting developments in this field include: the recent and upcoming approval of a variety of novel agents, the use of measurable minimal disease testing to guide treatment, and novel monoclonal antibody-based and CAR T-cell therapies. As treatments become complex, the rising costs of treatment vs. the benefits that they bring has become a major topic of discussion.