Sunway Medical Centre consultant haematologist Datuk Dr Chang Kian Meng says the general public should go for health screenings religiously as they are helpful in detecting AML as well as other illnesses or diseases. — YAP CHEE HONG/The Star
Genetically-driven treatment for bone marrow cancers gives patients a high chance of remission and cure
IN A short span of a week, one could turn from being a healthy, cancer-free individual to one who has acute myeloid leukaemia (AML) – an aggressive cancer that can progress rapidly without treatment.
Sunway Medical Centre consultant haematologist Datuk Dr Chang Kian Meng says AML is essentially a type of cancer which occurs within the bone marrow – whereby the bone marrow makes a large number of abnormal blood cells.
He explains that each person’s bone marrow produces blood stem cells (immature cells) that mature over time and into cells in the myeloid line or the lymphoid line.
AML occurs due to a problem with blood stem cell development in the myeloid line.
“A person can be healthy and well one week before and suddenly develop AML.”
Noting that some acute myeloid leukaemia subtypes can be more aggressive and less responsive to conventional treatments, Dr Chang says patients with AML generally may face problems with severe bleeding, infection and anaemia.
This is a serious health problem that needs treatment as soon as possible.
Hence, it is important to pay attention to the signs and symptoms our body sends to us.
Have a stubborn flu or chest infection that you can’t get rid of? These could be early signs of AML to look out for.
More common symptoms would include recurrent fever, gum bleeding, bruising easily, fatigue and pallor.
According to Dr Chang, previous chemotherapy treatments, exposure to radiation in the environment (such as nuclear radiation) or to chemicals like benzene, having certain congenital syndromes or inherited disorders and possibly high stress levels and smoking may predispose to the risk of AML.
“Ageing is also a risk factor. As all of us age, a small percentage of DNA damage in our stem cells occurs. They accumulate over time and could trigger and form leukaemia.
“Individuals who have previously gone through chemotherapy also have a higher chance of developing secondary AML.
“Generally, AML patients are between the ages of 50 and 70. However, I have treated patients aged between 30 and 40s or younger” shares the expert in haematology, adding that health screenings may be helpful in detecting the disease at an early stage.
AML targeted treatment
Following much advancement in science and technology, cancer treatments have expanded to include chemotherapy, radiation therapy, stem cell transplant and targeted therapy – an effective and less intensive treatment towards an AML patient’s body.
Pointing out that not all cancer patients respond well to chemotherapy, Dr Chang advises patients to first determine the type of AML they have to enable proper prognosis for the most suitable therapy.
He further explains that a stem cell mutation called the FMS-like tyrosine kinase-3 internal tandem duplication (FLT3-ITD) is the most frequently detected genetic aberration in AML patients – approximately 30% of them have the FLT3-ITD mutation.
“The FLT3-ITD is a driver mutation, meaning it is the mutation which causes leukaemia.
“AML patients with the FLT3-ITD do not respond as well to chemotherapy and would need to undergo bone marrow transplant to be cured.
“They are highly likely to face relapse if this driver mutation is not blocked.”
Dr Chang recommends that patients seek their respective physician’s professional opinion on the latest treatment options that best fit their condition as there are newer and more effective medications used in targeted therapy for AML patients who have developed resistance towards chemotherapy.
“Some patients who have gone through targeted therapy using the new substance were able to control the leukaemia.
“They went into remission in spite of having failed other chemotherapies.
“Once in remission, these patients would then be able to receive a definitive treatment, which is bone marrow or stem cell transplant,” he says.
Dr Chang adds about 50% to 60% of AML patients worldwide can be cured by chemotherapy, or chemotherapy with bone marrow transplantation.
However, 40% of AML patients would still lose the battle due to relapse or forming a resistance towards chemotherapy.
The effect of these products may vary between individuals. Patients are encouraged to consult a medical practitioner for advice.
“Drugs should not be taken unnecessarily.
“However, there would be times where relying on our own immune system to overcome a certain condition is simply not enough – especially when the illness or disease has overwhelmed the immune system. This is when drugs are needed to control and treat the disease,” he says.
This article is brought to you by Astellas Pharma.
