Published on March 15, 2016
At the 58th American Society of Hematology (ASH) Annual Meeting & Exposition, Dr Susan O’Brien, Professor in the Department of Leukemia at The University of Texas MD Anderson Cancer, talks about the role of major cancer centres in the care of patients with acute myeloid leukaemia (AML). Major cancer centres dedicated to the care of AML may be sites of clinical research, so although patients can expect to receive standard therapy wherever they are treated, these cancer centres may offer new and more effective therapies in clinical trials. In addition, teams of experts in these centres may be able to better manage the side effects of treatment of AML.
This programme has been supported by Pfizer, through an unrestricted educational grant to the Patient Empowerment Foundation
Transcript | Should I Look for a Major Cancer Center Dedicated to AML?
My own opinion is that anybody diagnosed with AML should really be getting a second opinion at a major centre. It is a very specialised disease and there are some complications that can ensue from treating the underlying disease. Often what happens is that patients are told, well, it’s acute leukaemia and maybe the white blood cell count is high and so we don’t really have time to refer you any place. We need to get started now.
That’s not exactly true. Yes, it’s acute leukaemia and you don’t want to be waiting weeks, but what we and others have found over the years is that if a patient has a high white blood cell count, and you do want to get it down, there’s an oral chemotherapy agent called hydria… Hydroxyurea, which really has no side effects. It won't get rid of the AML. It’s not going to get the person into remission. But it can bring the white count down fairly quickly and allow a bit of a window to get that expert opinion, which I think, again, is very important.
So I don’t think people should just accept, it’s acute, we’ve got to start today. And that’s important because once you embark on a path of treatment, you’re, kind of, stuck on that. Right? I mean, you can’t give chemotherapy and a week later decide, well, I don’t think I want that treatment; I want something else. It’s a little bit too late then. So I think it’s very important and it’s also important to know that most major centres, if they get called about a acute leukaemia patient, will see the patient within a day, because they understand that there’s some urgency here. So generally I think that’s extremely important.
The therapy… Are not necessarily different in investigational centres, the standard therapy, but, of course, they have clinical trials also. And then the person can hear about the trial that may be beneficial to them. Don’t forget, any great drug that’s approved by the FDA was utilised first in a clinical trial. And so people that were on those clinical trials potentially have access to what could be - not always - but it could be a really great drug well… Months to years even before it becomes available. And those are, kind of… Clinical trials are going to be at major centres.
Even if the patient, say, doesn’t qualify for a trial, and they’re going to get what’s more or less the standard therapy, they may decide to have it at home, but they may also want to know that the chemotherapy for AML is… It has some side effects: you do lose your hair; it can cause some nausea; it can cause some diarrhoea. But the, but the biggest risk when you’re getting AML chemotherapy are not those acute side effects, which occur over several days while the patient’s getting the drugs, it’s the fact that right now, in order to clear out that bone marrow to clear out the leukaemia, we have to give chemotherapy that knocks out the whole bone marrow.
So what does that mean? That means to get rid of leukemic cells, we have to get rid of all the cells that are in the bone marrow. Now, often times, people with newly-diagnosed acute leukaemia don’t have normal blood counts. Obviously, they can have high white counts from the leukemic cells, but they often have anaemia with low red blood cells or low platelets because of the leukaemia, kind of, crowding out the marrow. But even people with normal blood counts, relatively normal, all of the counts are going to drop and go down very low. That’s a necessary side effect of being able to empty out the marrow.
And the issue when that happens is that there are several risks. Right? When you don’t have normal white blood cells, you’re at risk from infection. When you’re anaemic, that’s the easy one to treat; you can get a red blood cell transfusion. If your platelets are low, you’re at risk for bleeding. Now, we can give platelet transfusions, but we can never get the platelets all the way to normal.
So the point I'm making is that it’s not the side effects per se of the chemotherapy that create the risk or the difficult time when you have to be really careful, it’s that all the counts are going to go down. So the point I'm making is that even if somebody’s getting standard therapy, if they’re being treated at a centre by physicians who’ve really had not had much experience with acute leukaemia patients, that can be the risk, not the chemo itself.