20019 Update on Acute Myeloid Leukemia - Aplastic Anemia
Transcript Of 20019 Update on Acute Myeloid Leukemia - Aplastic Anemia
20019 Update on Acute Myeloid Leukemia: When and If a Transplant is an Option
James M. Foran, MD FRCPC Associate Professor of Oncology Chair, Acute Leukemia & Myeloid Neoplasms Disease Group,
Mayo Clinic Cancer Center Jacksonville, FL
AA•MDS International Foundation, 2019 Patient & Family Conference Mayo Clinic, Jacksonville FL, November 16th, 2019
©2011 MFMER | slide-1
What is Leukemia?
• Greek: “White Blood” • Cancer of bone marrow (blood-producing) cells
• Immature primitive BM cells, proliferative - acute • Abnormal Complete Blood Count • Short-term survival without therapy • Prognosis varies greatly
• Requires detailed pathology review & diagnosis
©2011 MFMER | slide-2
AML ALL
©2011 MFMER | slide-3
AML (2019) Cases: 21,450 Deaths:10,920
Siegel, CA: A Cancer Journal for Clinicians 69:7-34, 2019
Epidemiology of Leukemia Relevance in the Clinic
• The causes of cancer are largely unknown in individual
patients
• Deeply relevant to patients and their families • “Why did this happen to me?” 1 • Impact of the cause on the disease course • Risk of recurrence
• Interventions, appropriate lifestyle changes, etc.
• Recognition of Familial Risk • Impact of specific leukemia risk factors on genetics,
prognosis and outcome after diagnosis largely unstudied
1Dizon DS: ASCO Connection, 09 April 2015
©2011 MFMER | slide-5
AML Epidemiology Exposures Identified in Case-Control Studies
Obesity Acetaminophen Aspirin Smoking Farm/Rural habitat Benzene Ulcerative Colitis Chemo/Radiation
Relative Risk of developing
AML 2-fold
1-2 Lower ?
2 2
2-10 4
2-10
Some risk factors that have been associated with AML development identified in PopulationBased Case-Control Studies • Not proof of
causality, but suggests increased risk • Further studies ongoing
Ross, Cancer Epidemiology Biomark & Prev. 13:1810, 2004. Sandler, JNCI 85:1994, 1993
Sinner, Cancer Epidemiol Biomark & Prev. 14:2446, 2005. Natelson, Am J Hematol 82:826, 2007
Ross, Cancer Epidemiol Biomark & Prev. 20:1741, 2011.
Johnson, Ca Caus. & Contr. 23:1083, 2012
©2011 MFMER | slide-6
©2011 MFMER | slide-7
Normal Bone Marrow Biopsy
©2011 MFMER | slide-8
AML BM biopsy
©2011 MFMER | slide-9
Acute Leukemia
• Complications of Leukemia:
• Infection
Rapid onset, esp. if neutropenia
• Bleeding
Low platelets, low fibrinogen DIC
• Clotting
Hypercoagulable, even if low platelets
• Fatigue
Anemia, transfusions
• Leukostasis “Sludging” - confusion, stroke, bleed,
cardiopulmonary symptoms
• Importance of coordinated clinic evaluation & hospital care • Acute Leukemia Must see in 24-48 hours whenever possible • Frequently direct hospital transfer , or being admitted for
urgent evaluation and initiation of treatment
• ~4 week intensive “remission induction” therapy
©2011 MFMER | slide-10
James M. Foran, MD FRCPC Associate Professor of Oncology Chair, Acute Leukemia & Myeloid Neoplasms Disease Group,
Mayo Clinic Cancer Center Jacksonville, FL
AA•MDS International Foundation, 2019 Patient & Family Conference Mayo Clinic, Jacksonville FL, November 16th, 2019
©2011 MFMER | slide-1
What is Leukemia?
• Greek: “White Blood” • Cancer of bone marrow (blood-producing) cells
• Immature primitive BM cells, proliferative - acute • Abnormal Complete Blood Count • Short-term survival without therapy • Prognosis varies greatly
• Requires detailed pathology review & diagnosis
©2011 MFMER | slide-2
AML ALL
©2011 MFMER | slide-3
AML (2019) Cases: 21,450 Deaths:10,920
Siegel, CA: A Cancer Journal for Clinicians 69:7-34, 2019
Epidemiology of Leukemia Relevance in the Clinic
• The causes of cancer are largely unknown in individual
patients
• Deeply relevant to patients and their families • “Why did this happen to me?” 1 • Impact of the cause on the disease course • Risk of recurrence
• Interventions, appropriate lifestyle changes, etc.
• Recognition of Familial Risk • Impact of specific leukemia risk factors on genetics,
prognosis and outcome after diagnosis largely unstudied
1Dizon DS: ASCO Connection, 09 April 2015
©2011 MFMER | slide-5
AML Epidemiology Exposures Identified in Case-Control Studies
Obesity Acetaminophen Aspirin Smoking Farm/Rural habitat Benzene Ulcerative Colitis Chemo/Radiation
Relative Risk of developing
AML 2-fold
1-2 Lower ?
2 2
2-10 4
2-10
Some risk factors that have been associated with AML development identified in PopulationBased Case-Control Studies • Not proof of
causality, but suggests increased risk • Further studies ongoing
Ross, Cancer Epidemiology Biomark & Prev. 13:1810, 2004. Sandler, JNCI 85:1994, 1993
Sinner, Cancer Epidemiol Biomark & Prev. 14:2446, 2005. Natelson, Am J Hematol 82:826, 2007
Ross, Cancer Epidemiol Biomark & Prev. 20:1741, 2011.
Johnson, Ca Caus. & Contr. 23:1083, 2012
©2011 MFMER | slide-6
©2011 MFMER | slide-7
Normal Bone Marrow Biopsy
©2011 MFMER | slide-8
AML BM biopsy
©2011 MFMER | slide-9
Acute Leukemia
• Complications of Leukemia:
• Infection
Rapid onset, esp. if neutropenia
• Bleeding
Low platelets, low fibrinogen DIC
• Clotting
Hypercoagulable, even if low platelets
• Fatigue
Anemia, transfusions
• Leukostasis “Sludging” - confusion, stroke, bleed,
cardiopulmonary symptoms
• Importance of coordinated clinic evaluation & hospital care • Acute Leukemia Must see in 24-48 hours whenever possible • Frequently direct hospital transfer , or being admitted for
urgent evaluation and initiation of treatment
• ~4 week intensive “remission induction” therapy
©2011 MFMER | slide-10