Expert Videos

Module 1: Understanding AML

What is AML and what causes it?
Expert Dr. David Steensma describes acute myeloid leukemia (AML), a blood and bone marrow cancer that happens when a person has too many of a certain type of abnormal cells called blasts. While AML is most common in people over 60, it can happen at any age. People who have had radiation or certain types of chemotherapy for cancer, have a disorder called myelodysplastic syndrome (MDS), smoke or work with certain chemicals have a higher risk of AML.
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What are the subtypes of AML?
In this video, expert Dr. David Steensma explains that there are a number of types of acute myeloid leukemia (AML). Types include treatment-related AML, also called secondary or therapy-related AML (tAML), AML with myelodysplasia-related changes (AML-MRC), and acute promyelocytic leukemia (APL). The different types of AML can make it a challenge to match the treatment to each patient.
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What are the symptoms of AML?
Dr. Sandra Kurtin, an expert on acute myeloid leukemia (AML), describes some of the symptoms of AML in this video. Symptoms can come on suddenly and include fever, shortness of breath, weakness, fatigue, dizziness, and headaches. You may feel like you have the flu. You might also bruise or bleed easily. Some people have milder symptoms that appear over time, such as being very tired. Changes in the various types of blood cells produce different symptoms.
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What are the risk factors for AML?
In this video, expert Dr. Sandra Kurtin describes some of the risk factors for acute myeloid leukemia, or AML. Age is a main risk factor, and most people diagnosed with AML are over 65. Other risk factors include smoking, having radiation therapy or some types of chemotherapy, being exposed to a chemical called benzene and having certain genetic changes.
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Can AML be prevented?
Dr. David Steensma, an expert on acute myeloid leukemia (AML), explains that doctors do not yet know exactly how to prevent AML. In the future, we may have screening tests for adults. For now, avoiding smoking and tobacco products, or quitting smoking if you smoke, may reduce your risk. Although some AML can develop after treatment for another type of cancer, the benefits of that treatment may outweigh the risk of getting treatment-related AML, or tAML. It is important to talk with your doctor about this.
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What is the prognosis for AML?
In this video, Dr. Sandra Kurtin, an expert on acute myeloid leukemia (AML), explains that the outlook or prognosis for someone with AML depends on the type they have. Some types of AML have a favorable outlook or prognosis, while other types, including treatment-related or secondary AML, have a poor outlook without a stem cell transplant. Younger people with AML usually have a better outlook than older people. Learning about your AML subtype and any genetic changes you have is very important for understanding your AML prognosis.
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Module 2: Understanding AML-MRC and tAML

What is AML with myelodysplasia-related changes (AML-MRC)?
Expert Dr. David Steensma explains in this video that acute myeloid leukemia with myelodysplasia-related changes is a specific type of AML. It is also called AML-MRC. In this type, the bone marrow not only has an unusually high number of the immature stem cells called blasts, but many other abnormal cells. These abnormalities are caused by a previous condition called myelodysplastic syndrome or by genetic changes. The outlook for AML-MRC is not as good as for other types of AML, but depends on what genetic abnormalities are present.
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What is treatment-related AML (or tAML)?
In this video, Dr. Sandra Kurtin explains treatment-related acute myeloid leukemia, or tAML. This type of AML develops in people who previously had cancer treatment with radiation or certain types of chemotherapy. These treatments can damage the cells. You may develop treatment-related AML just two or three years after cancer treatment. Or it may appear as late as 10 years after treatment. The timing depends partly on what type of treatment you had.
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What is secondary AML?
Expert Dr. David Steensma explains that secondary acute myeloid leukemia, or secondary AML, is AML that happens in someone who has another condition, such as myelodysplastic syndrome (MDS) or another blood disorder. It can also happen in people who have certain conditions such as Down syndrome. AML-MRC and tAML are two types of secondary AML because they happen in people who already have, or had, another condition.
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What are the symptoms of AML-MRC or tAML?
Expert Dr. Sandra Kurtin explains that the signs of acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) and treatment-related acute myeloid leukemia (tAML) are different from AML that develops on its own, or “de novo.” With these types of AML, you may have low levels of white and red blood cells and platelets. In de novo AML, which develops without a previous condition, the white blood cell count is normally going up, sometimes very high. Symptoms of AML-MRC and tAML can also include fever, infections, bleeding or bruising easily and feeling tired.
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What are the risk factors for AML-MRC or tAML?
Expert Dr. Sandra Kurtin explains the risk factors for two types of AML, acute myeloid leukemia with myelodysplasia-related changes, or AML-MRC, and treatment-related acute myeloid leukemia, or tAML. The main risk for AML-MRC is having another bone marrow disease that can develop into AML, or certain abnormal genes. The only risk factor for tAML is treatment with radiation or specific chemotherapy drugs known to raise AML risk.
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What is multilineage dysplasia?
Expert Dr. David Steensma explains that “multilineage dysplasia” is a condition where at least two types of blood cells in the bone marrow are abnormal. Each of the main blood cell types is called a “lineage.” Dysplasia means they are not forming correctly. For example, the red cells and white cells may both be forming abnormally. Or the red or white blood cells and platelets may be forming abnormally.
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What is the outlook for AML-MRC, tAML, and secondary AML?
Acute myeloid leukemia expert Dr. Sandra Kurtin explains that the outlook for people with acute myeloid leukemia with myelodysplasia-related changes (AML-MRC), treatment-related AML (tAML) or secondary myelodysplastic syndrome (secondary MDS) is usually less good than for de novo AML. People who can have a stem cell transplant, also called a bone marrow transplant, have a better outlook with these secondary types of AML. Clinical trials of new treatments may also improve the outlook for AML-MRC, tAML and secondary AML.
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Module 3: Diagnosing AML, AML-MRC, and tAML

How is AML diagnosed?
In this video, Dr. Sandra Kurtin, an expert on acute myeloid leukemia, explains how your doctor may find AML. You may see your doctor for symptoms such as being very tired or bleeding or bruising easily. Your cancer doctor may diagnose AML if you are already being treated for myelodysplastic syndrome (MDS), or had previous cancer treatment that can lead to treatment-related AML (tAML). An examination, blood tests, and a bone marrow biopsy are used to find signs, including genetic changes, and make the diagnosis.
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What is a bone marrow aspiration and biopsy? What should I expect?
A bone marrow biopsy is a procedure to take a sample of your bone marrow. Aspiration means taking a sample of the liquid bone marrow as well as solid marrow. The doctor or a technician usually takes the sample from your hip. Dr. David Steensma, an expert on acute myeloid leukemia (AML), explains that some people tolerate the procedure well and others have pain. You receive a local anesthetic to keep you more comfortable, and may also take a sedative. The procedure takes just a few minutes after everything is ready.
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How do doctors tell de novo AML, AML-MRC, and tAML apart?
Dr. David Steensma, an expert on acute myeloid leukemia (AML), explains that your medical history and cells from a bone marrow biopsy help doctors tell types of AML apart. Chemotherapy or radiation in the last 10 years indicates treatment-related AML (tAML), especially if there is a certain genetic pattern. AML with myelodysplasia-related changes (AML-MRC) has certain cell changes that can be seen under a microscope. Without these changes or prior treatment, it is likely de novo AML. People with de novo AML also tend to have higher white blood cell counts.
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What’s the connection between MDS and AML-MRC?
Dr. Sandra Kurtin, expert on acute myeloid leukemia (AML), explains that myelodysplastic syndrome, or MDS, is also a disorder of abnormal cells in the blood and bone marrow. MDS can develop into AML-MRC because it is also a malignancy, or cancer, of the bone marrow cells. Having a higher-risk type of MDS raises the risk of developing AML later.
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Is AML staged?
In this video, Dr. David Steensma, an expert on acute myeloid leukemia, explains that doctors do not measure how serious AML is by “staging” it. Solid tumors are measured by their size and how far they have spread in the body. This is called staging. But AML affects the bone marrow and blood. Because it affects the blood, it is usually widespread by the time doctors find it.
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What is most important for me to ask my doctor about my AML?
Dr. Sandra Kurtin, expert on acute myeloid leukemia or AML, explains that the outlook and treatment options for someone with AML are different depending on the type of disease, any genetic changes that are present, and other factors. Knowing your AML subtype, including the results of chromosome and genetic tests, is very important in knowing your outlook and planning for treatment.
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Module 4: Treating AML

What are the main treatment options for AML? What are the goals of each treatment?

Expert Dr. David Steensma explains that the goal of treating acute myeloid leukemia (AML) is to help you live as long and well as possible. Some AML can be cured and other cases may go into remission. This means the disease is not cured, but is also not active.

Many people with AML cannot have intensive treatment, such as high-dose chemotherapy, because of their age or other health problems. They may have blood transfusions or low-intensity chemotherapy. Some patients may have a stem cell transplant, also called a bone marrow transplant. If your AML is treated and comes back, you may have treatment designed for the specific genetic changes you have.

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What are induction and consolidation chemotherapy for AML?
Dr. Sandra Kurtin, an expert on acute myeloid leukemia (AML), describes the induction and consolidation phases of chemotherapy treatment for this disease. The first phase of treatment is called induction chemotherapy. It is designed to eliminate the blasts, or abnormal cells, that are too numerous in the bone marrow. Induction chemotherapy is usually done in the hospital. Once the blast numbers are reduced, you have additional chemotherapy called “consolidation” to make sure the levels of these cells remain low.
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What is a stem cell transplant? Who is a candidate for it?
Acute myeloid leukemia (AML) expert Dr. David Steensma explains how a stem cell transplant works. Healthy cells, usually from a donor, are given to the patient after high-dose chemotherapy destroys the original blood-forming cells. These are the cells that have AML, so replacing them may cure the disease. Younger patients who are healthy may be the best candidates for stem cell transplant. However, older people who are healthy enough may also qualify.
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What is meant by “targeted therapy” for AML?
Dr. Sandra Kurtin, an expert on acute myeloid leukemia (AML), describes how cancer treatments can now “target,” or treat, specific ways the cancer cells work. Targeted therapy can affect the cancer cells without affecting healthy cells as much as traditional chemotherapy does. This can reduce side effects and changes after cancer treatment. Dr. Kurtin gives examples of several different treatments that target AML.
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What can be done to treat AML if it doesn’t go into remission or comes back?
Dr. David Steensma, expert on acute myeloid leukemia (AML) explains that some cases of AML do not go into remission, or become less active, or AML may return after treatment. The U.S. Food and Drug Administration has recently approved several new drugs to treat AML when this happens. However, people with AML that comes back after a stem cell transplant face more challenges.
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What does “complete remission” and “measurable residual disease” mean?
Dr. Sandra Kurtin, an expert on acute myeloid leukemia (AML), explains the terms complete remission and measurable residual disease. Complete remission means that less than 5 percent of blood-forming cells in the bone marrow are blasts. There are no blasts in the blood and the numbers of white cells, red cells and platelets are normal. However, sensitive tests may find some abnormal cells left in the blood or bone marrow, even if they cannot be seen.
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What does “hematologic recovery” mean?
Acute myeloid leukemia (AML) expert Dr. Sandra Kurtin explains the term hematologic recovery. This means levels of specific types of blood cells have returned to normal, whether they were too low or too high. For example, your level of white cells, red cells, or platelets may return to normal or near normal after treatment, even if AML is still present. Some people make a hematologic recovery and others do not.
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What is the outlook for patients with AML?
Dr. David Steensma explains that the outlook, or prognosis, varies widely from cure to a few months or years of life. The factors influencing the outlook include age, type of AML (AML subtype), general health and genetic changes present in the blasts. Younger patients and those with de novo AML often do better than those with treatment-related AML (tAML) or AML with myelodysplastic changes (AML-MRC).
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What new treatments are in development for AML?
Acute myeloid leukemia (AML) expert Dr. David Steensma describes encouraging developments in treating AML. This includes the FDA approval of eight new treatments in the past few years and the many clinical trials under way for AML. Medications that target specific mutations responsible for AML are also available as targeted therapy. Some of these target the bone marrow environment where AML cells develop. New chemotherapy drugs for AML are also being developed.
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How can I choose a clinical trial for AML?
Dr. Sandra Kurtin, expert on acute myeloid leukemia (AML), describes how to choose a clinical trial, or a research study that involves humans. You may want to try a new medication that is not yet available to the public. Your doctor may recommend joining a trial at a specific stage, or phase, of new medication development. Trials have guidelines for who qualifies to be in them, but Dr. Kurtin emphasizes that there is often one that fits your situation and all patients are encouraged to consider a clinical trial.
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What is immunotherapy for AML?
Dr. David Steensma, expert on acute myeloid leukemia (AML), explains that immunotherapy means helping your immune system fight off the abnormal cells in this cancer or replacing them with healthy cells from a donor. When cells are replaced it is called a stem cell transplant. Other forms of immunotherapy stimulate or attack certain parts of a cancer-fighting cell or cancer cell. They may be in the form of medication given along with chemotherapy.
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If I have AML, what should I watch out for in daily life?
Acute myeloid leukemia (AML) expert Dr. Sandra Kurtin explains that patients with AML and their caregivers should try to stay as generally healthy as possible. Avoiding infections, eating a healthy diet and exercising can all make a difference. You also stay healthier if you and your caregivers understand your type of AML (AML subtype) and how to cope. Staying hopeful, even with a poor outlook, helps you appreciate daily life and tolerate treatment better. Your health care team can adjust treatment to your personal wishes if you tell them what you want.
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This educational activity has been developed by the Myelodysplastic Syndromes Foundation, Inc. and Mechanisms in Medicine Inc.

This activity is supported by educational grants from AbbVie, Celgene Corporation, Daiichi Sankyo, Jazz Pharmaceuticals and Takeda Oncology.

This website is part of the Animated Patient™ series developed by Mechanisms in Medicine Inc., to provide highly visual formats of learning for patients to improve their understanding, make informed decisions, and partner with their healthcare professionals for optimal outcomes.