When patients are diagnosed with cancer, their most stressing question is not about how the disease occurred nor even what the best treatment is. It is usually “Is it treatable” or “How much time do I have?” and “How much time will this therapy give me?”. Cancer is as old as humanity itself, and it has always been a disease with a grim outcome. It is even considered a normal cause of death just like heart conditions and strokes. Each year, more than half a million humans die of cancer, making it the 6th commonest cause of death in most countries. Modern medicine has allowed cancer patients to have better outcomes, survive for longer, or even achieve complete remission in some cancers.
Acute myeloid leukemia: the answer is more complex
Cancer is far from being a homogenous disease, and different cancers have different presentations and outcomes. This is not only seen in cancers arising from different tissues, but also in the same cancer arising from the same tissue depending on its biological behavior which, in turn, depends on the following factors:
- The type of genetic mutation present in that cancer.
- Whether targeted therapy has been developed for it.
- Patient-related factors like age and overall health status.
- Whether a vital organ is affected by the cancer or its metastases.
› In acute myeloid leukemia, the most significant factors that affect the outcome are:
- The patient’s age: Older patients tend to have more resistant cancer to chemotherapy as well as a high rate of complications and poor tolerance to such medications. They also tend to have other blood disorders that either led to acute leukemia in the first place or coexist with it, worsening the patient’s general condition.
- Genetics: when you are diagnosed with leukemia, your doctor will usually ask for a bone marrow biopsy which also entails several genetic and cellular analyses. Detection of certain mutations in the genetics of the cancer is crucial to treatment decisions and evaluating the outcome. Some mutations like the TP53 and FLT3 are associated with worse outcomes, while other mutations like t(8;21) and t(15;17) are associated with very good outcomes – the “t” here refers to the translocation of genetic material between two chromosomes whose numbers are mentioned-.
- White blood cells count: White blood cell count is one of the main indicators of survival in acute myeloid leukemia since infection is the commonest cause of death, and its occurrence is directly proportional to the fall of white cell count.
- Initial response to chemotherapy: This is a general theme in blood disorders and cancer. The earlier a patient responds to chemotherapy, the more likely they are to survive on the long term. Response to chemotherapy is assessed by what we call a complete remission, which is the disappearance of all signs of the cancer whether clinical symptoms or lab findings.