Hopeful treatment available

Acute leukemia is an acquired DNA-genetic defect involving the white blood cell progenitor cells, located mostly in the bone marrow. Approximately 14,000 new cases are diagnosed in the US annually, with the median age being 70 years old.

This cancer results in the unregulated growth of early, immature cells referred to as blasts, eventually crowding out the marrow space, decreasing normal blood cell production. As a result, bad cells are released into the blood; due to marrow overcrowding not enough good blood cells are produced, resulting in severe anemia, bleeding, infection, and death. Leukemia (lymphoid) is common in children [thus accounting for the most life-years lost due to cancer of all malignancies], increasing in incidence as we age; the majority of adult acute leukemia referred to as AML (myeloid). The term “acute” historically referred to the likelihood of death within 3 months of diagnosis without therapy; it now refers to the presence and quantity of blast cells present.

Important risk factors for AML are age, male sex, smoking, exposure to radiation, toxic chemicals (such as benzene), and previous exposure to chemotherapy for other cancers. For example, anthracycline drugs, commonly used in patients with breast cancer, are associated with a 1% risk of AML.  Prior chemotherapy exposure AML is referred to as secondary leukemia, and has a very unfavorable outcome with standard therapy. Being elderly, as well as a poor “performance status” are predictors of poor treatment outcomes in AML.

The goal of treatment is to achieve a complete remission (CR); essentially a normalization of blood counts, and an absence of leukemia cells in the bone marrow. Failure to achieve this CR is incompatible with cure. Despite tremendous progress in cancer treatment for solid tumors, the initial management of AML has not changed much over the past several decades. Initial therapy or “Induction” is a 2-drug infusion over 7 days, followed by a several week hospital stay to treat infections.

Once in CR, more intensive “consolidation” chemotherapy is given, with the goal of this treatment being to kill off hidden leukemic cells in the marrow. Even with intense therapy, 4 year survival is only 30% in under 60 years olds (and about 9% over 60), leading to consideration of bone marrow transplantation as an intensive form of consolidation therapy. The notion is that health stem cells [which will reconstitute the entire bone marrow] can replace a leukemic marrow and also attack any residual leukemic blasts, preventing disease relapse. This treatment is very expensive, risky, associated with a 30% mortality, and requires the availability of a healthy compatible donor, present in only a small minority of cases.

Patients who do not achieve complete remission or who relapse after getting into remission have few options. Because there is no standardized care for these patients, and available treatments are relatively ineffective, options should include clinical trials.  A newly opened trial, available through Family Cancer Center, offers a local option for these patients.  Partnering with Baptist Memorial Hospital-Memphis, patients will receive study treatment on the Myelosuppression Unit under the supervision of Principal Investigator, Dr. Donald Gravenor.  

This promising study offers a new, first-in-class quinilone-derived anti-cancer agent with cytarabine, versus high dose cytarabine alone [both Cytarabine and the experimental drug are provided by the sponsor]. If good results are achieved, this generally well tolerated agent could be moved into the first line of AML treatment, and have even a bigger benefit.

For a complete listing of our studies, please visit our web page at familycancercenter.com. 

‑ Dr. Donald Gravenor  www.familycancercenter.com

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