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Cancer – Acute Leukemia Risk Status

Sanjay Juneja, MD Sanjay Juneja, MD February 2, 2021
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Transcript

"Acute leukemia is a diagnosis that happens often later in life. It's something associated with the sixth, seventh decade of life, and it's very aggressive and hard to treat. The most important thing that you need to ask your oncologist when you get diagnosed with acute myeloid leukemia is, what is the risk status? Is it good risk or is it intermediate or poor risk? The reason that this is so important is if it's good risk, that may mean you do not need and often don't, a transplant, what's called an allograph transplant. That means in a good risk, acute leukemia, you just need high intensity or pretty aggressive chemotherapy. After that chemotherapy, which usually takes about 30 days to recover from the first seven days, after that, if you achieve a remission, you'll just need what's called consolidated chemotherapy to just basically concrete or cement that remission down. That is the treatment modality for good risk AML. Chemo, heavy chemo, hopefully get a remission and consolidate that remission with chemotherapy at the other end.

Now intermediate and poor risk for the most part, those have a high recurrence and relapse rate. We're doing that chemotherapy up front. It's not enough because the relapse is so high. And instead of consolidating just with chemo and the other side you need to do what's called an Allo transplant where basically you take the bone marrow cells from a donor, you wipe out your bone marrow cells with that intense chemo and instead of consolidating with more chemo you consolidate with somebody else's stem cells to refertilize your marrow. That is the ideal recommended way to treat intermediate or poor risk AML. Now, Allo transplants are very intense, require strong social support, and have a lot of risks. So a lot of times they're not undergone when patients are over 70 or 75, but again, the most important stratification when you have an AML diagnosis, is is it good, or is it intermediate and poor? And the things that constitute this are basically what's called your cytogenetics. They basically look at your chromosomes and see what mutations you have as well as some other factors that they look at more closely. So you need to ask your oncologist, do you have those things and kind of know which pathway you're going for."

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