Acute myeloid leukemia (AML) is a fast-growing cancer in your blood and bone marrow. A stem cell transplant, which gives you healthy new stem cells from a donor, is the only cure.
But a stem cell transplant isn’t an option for everyone. If you can’t have one, your doctor will use other treatments to try to put you into remission. That means clearing out enough cancer cells from your body that none are detected in your bone or blood marrow.
About 50% to 80% people with acute myeloid leukemia go into remission after treatment. But about half the time, the cancer returns months or years later.
What determines if your cancer will come back?
“Prognosis in leukemia is almost completely determined by genetics,” says Andreas Klein, MD, interim chief of hematology oncology and associate director of the Cancer Center at Tufts Medical Center in Boston.
Here’s what that means and why it matters.
The Role That Chromosomes and Genes Play in AML
Random changes in your blood cells can happen during your life. Experts still aren’t sure what triggers them, but they occur more often as you get older.
Only rarely is AML caused by a genetic change that’s passed down through your family.
Chromosome changes
Some types of leukemia, like AML, are because of changes across chromosomes, the long strands of DNA inside each of your cells.
“Chromosomes are the blueprints for making proteins,” explains Klein. “Sometimes the blueprints are missing, flipped backwards, or torn and reassembled in the wrong order.”
These changes can result in brand new proteins that interrupt the normal function of your cells. “It’s like a house with the kitchen installed backwards, or a dining room attached to half of the garage,” Klein says. “The result can be chaotic.”
Special testing can look for chromosome changes. Some types are linked to a worse or better outcome after AML treatment.
Chromosome changes linked to a better outcome
According to the American Cancer Society, these are:
- Translocation (change) between chromosomes 8 and 21
- Translocation or inversion (reversed order) of chromosome 16
- Translocation between chromosomes 15 and 17
Chromosome changes linked to a worse outcome
This list includes:
- Deletion (loss) of part of chromosome 5 or 7
- Translocation or inversion of chromosome 3
- Translocation between chromosomes 6 and 9
- Translocation between chromosomes 8 and 16
- Translocation between chromosomes 9 and 22
- Abnormality of chromosome 11
- Loss of a chromosome (monosomy)
- Changes to 3 or more chromosomes
Gene mutations
Your bone marrow is basically a blood-making factory. “[It] makes more than 200 billion new blood cells every day throughout your life,” Klein says.
Many genes provide instructions for the proteins that are in charge of this growth. “Mutations, or errors, in any number of these genes cause cells to grow without restraint, even in the face of treatment,” says Klein.
Think of gene changes like typos on a page. Although they may seem small, “they can change the function of critical proteins that should tell [your] cells when to grow or when to stop,” Klein says.
Many different genetic mutations can happen inside AML cells. Like chromosome changes, some of these changes can raise your risk for a better or worse outcome.
Gene mutations linked to a better outcome
These are:
- Some types of FLT-3
- NPM1
- CEBPA
- t (8;21) and inv (16)
Gene mutations linked to a worse outcome
Researchers have identified:
- Some types of FLT-3
- TP53
- RUNX1
- ASXL1
- BCOR
- EZH2
- SF3B1
- SRSF2
- STAG2
- U2AF1
- ZRSR2
Other Factors That Can Affect Your Long-Term Outlook
Whether AML comes back after treatment can depend on other factors as well.
Your risk that it will return may be higher if:
- You’re over the age of 60
- You have a high white blood cell count at the time of diagnosis
- You have another blood disorder or blood infection
- AML started after you were treated with chemotherapy or radiation for another cancer
- AML has spread to your central nervous system
Your response to cancer treatment may also signal how well you’ll do after treatment. Everyone is different, but a quick response is linked to a positive long-term outcome.
Can I Lower the Chances That AML May Return?
Despite what you may see or read on social media, experts still don’t know if certain supplements or diets can prevent AML from coming back after treatment. But making healthy choices every day can benefit your overall health.
For instance, you can:
- Eat more healthy foods
- Try to be active on a regular basis
- Quit smoking
- Get to a healthy weight
Talk to your doctor about other changes you can make to protect your health.
Recent Advances in Understanding and Treating AML
Like all cancers, AML can bring a lot of fear and uncertainty. The good news is that experts are making progress in treating it.
“Thankfully, we have new treatments that aim to undo or counteract the effects of gene mutations and chromosomal rearrangements,” Klein says. “These ‘targeted’ treatments can stop [cancer] cells from growing and convince others to die.”
How Much Do You Need to Know About Your AML Treatment?
“You don't need to have a PhD in biology to have a basic understanding of what your medications are designed to do and how they work together to treat your leukemia,” Klein says.
If your doctor says something that you don’t understand, ask them to explain it in a different way or ask for a handout you can take home.
“It’s important to be informed about possible [treatment] side effects and to discuss any new symptoms with your care team,” Klein says. “Most side effects can be effectively managed, allowing you to receive all possible benefits of the treatment.”
Your doctor is also the best person to talk to about your outlook. And they can help you cope with worries that your cancer may return.
Show Sources
Photo Credit: DigitalVision/Getty Images
SOURCES:
Andreas Klein, MD, interim chief of hematology oncology, associate director, Cancer Center, Tufts Medical Center, Boston, Massachusetts.
Cleveland Clinic: “Acute Myeloid Leukemia (AML),” “Bone Marrow Donation.”
Blood Cancer UK: “Acute myeloid leukaemia (AML) prognosis.”
American Cancer Society: “Living as an Acute Myeloid Leukemia (AML) Survivor,” “What Causes Acute Myeloid Leukemia (AML)?” “Acute Myeloid Leukemia (AML) Subtypes and Prognostic Factors.”
National Cancer Institute: “Coping With Advanced Cancer Long Term.”
