Expert Videos

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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).

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.

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.

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.

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.

Dr. Jamile Shammo, an expert on acute myeloid leukemia (AML), explains what treatment failure and relapse in AML means, and describes its various forms. Treatment failure occurs when your AML treatment is not successful in eliminating all the leukemia from your bone marrow after initial therapy (induction chemotherapy). It could also mean that the leukemia came back (relapsed) after being well controlled after chemotherapy and entering a state known as remission.

Acute myeloid leukemia (AML) expert Dr. Barry Skikne explains that any person with AML is at risk for treatment failure and relapse in AML, however older persons tend to have an increased risk. In people over 60, treatment failure may be close to 50 percent. Patients can be stratified into low, intermediate, or poor risk disease based on the characteristics of their leukemia, and this stratification can help determine risk of treatment failure.

Dr. Jamile Shammo, an expert on acute myeloid leukemia (AML) at Rush University Medical Group in Chicago, explains the hematological processes that occur in AML treatment failure. She talks about the differences in relapse due to induction failure, versus relapse after being in a period of remission. She also discusses bone marrow biopsy and some of the signs and symptoms of treatment failure in AML.

Dr. Barry Skikne, an expert on acute myeloid leukemia (AML) at the University of Kansas Medical Center in Kansas City, describes how AML and leukemic cells may arise after treatment with chemotherapy and/or radiation therapy. He talks about prior exposure to various toxins (chemotherapy agents, radiation treatment, petrochemical toxins) that may put a person at increased risk of developing AML. He also explains the importance of long-term monitoring and explains residual disease versus complete remission.

Dr. Jamile Shammo, an expert on acute myeloid leukemia (AML), describes how common treatment failure and relapse is in AML. Unfortunately, relapse is common in AML. About half of people who go into remission will have a relapse of their leukemia. Treatment failure in the form of primary resistance to chemotherapy is less common in people under 60. She explains that in people under 60, about 35 percent experience treatment failure. In people over 60, treatment failure may be close to 50 percent. She also explains that the majority of relapses occur within two to three years of initial treatment.

Dr. Barry Skikne, an expert on acute myeloid leukemia (AML), explains that stem cell transplantation may be the best chance for curing AML, but not all patients are eligible for it due to various reasons which he discusses in this video. He explains that doctors consider AML cured after you are in remission for five years. Most relapses occur within two years after initial treatment, and for each year that passes beyond two years, the chance of relapse declines significantly. If AML relapses after a period of remission other treatments can be tried, as long as a person is healthy enough for them.

In this video, acute myeloid leukemia (AML) experts Dr. Jamile Shammo and Dr. Barry Skikne explain how targeted therapy impacts AML remission. Targeted therapy is a cancer treatment that can "target" specific mutations in an individual's leukemia. The experts describe how targeted therapy is being explored in various combinations to treat AML to achieve remission and prevent or delay relapse.

Acute myeloid leukemia (AML) expert Dr. Barry Skikne discusses the differences in AML remission in younger and older patients with AML. In elderly patients, the duration of remission may be shorter than younger patients, although this may not always be the case. Older patients may not be able to have the most intensive treatment commonly used in induction and consolidation due to age, other health conditions, or for other reasons, or they may have an aggressive type of AML or other conditions that keep them from receiving intensive chemotherapy.

Dr. Jamile Shammo, an expert on acute myeloid leukemia (AML), explains how AML classification helps predict treatment outcomes. Based on the genetics of your AML, doctors will classify your AML as favorable, intermediate, or adverse risk group (good, medium, or poor). Along with your age and other factors (such as your general health), your risk group helps determine your treatment plan.

Dr. Barry Skikne, an expert on acute myeloid leukemia (AML), discusses clinical trials for treatment failure or relapse in AML. Whenever possible, it is important to join a clinical trial for a new AML treatment. The knowledge gained helps to advance treatment for persons with AML. Dr Skikne explains the various benefits of participating in clinical trials, how they work, and what to expect. It is important to discuss all your treatment options, including clinical trials, with your doctor or cancer care team.

Dr. Jamile Shammo, an expert on acute myeloid leukemia (AML) at Rush University Medical Group in Chicago, discusses personalized treatment in AML and maintenance treatment. She talks about the benefits of personalized AML treatment and explains a typical approach in personalized patient care. Personalized maintenance treatment is not available currently, but she hopes it will be on the near horizon for patients with AML.

In this video, acute myeloid leukemia (AML) expert Dr. Barry Skikne explains the 3 phases of AML treatment, which are are induction, consolidation, and maintenance. Induction treatment is designed to put AML into remission, meaning less than 5% immature, leukemic cells in the bone marrow. Consolidation treatment is designed to kill any leukemia cells left behind in the body. If any are found, this is called minimal or measurable residual disease. After consolidation, maintenance treatment may help keep AML from coming back by killing more leukemic cells or keeping them to a low level.

In this video, acute myeloid leukemia (AML) expert Dr. Jamile Shammo discusses treatment challenges that elderly AML patients may often face. Older patients often have co-morbid conditions such as kidney or heart disease and are more vulnerable to AML than younger patients. Tolerability to induction chemotherapy may be less among elderly patients than younger patients. Some chemotherapeutic agents such as anthracyclines may present with cardiac toxicity in patients with heart disease. Elderly patients may have challenges due to both AML and MDS cytogenetic abnormalities. Elderly patients may have resistance to chemotherapy and experience adverse drug tolerability and may also be more vulnerable to infectious complications. Combination therapy such as azacitidine and venetoclax are given to elderly patients because of better tolerability and response rates to treatment in AML.

Dr. Barry Skikne, an expert on acute myeloid leukemia (AML) at the University of Kansas Medical Center in Kansas City, talks about some of the special considerations for treating frail elderly AML patients. Tolerability to intensive chemotherapy is challenging in frail elderly patients, and patients will quite often require hospitalization involving continuous intravenous infusion over 4 to 5 days with recovery lasting over 4-5 weeks. Elderly frail patients are closely observed for complications, especially if they have underlying heart, lung, or kidney disease. Less intensive treatment should be a consideration in frail elderly patients. Elderly patients can benefit from outpatient management. New oral treatments are being introduced which are more convenient for patients. Standard treatments such as azacitidine and decitabine may be given in combination; newer regimens present opportunities for treating elderly AML patients.

Dr. Jamile Shammo, an expert on acute myeloid leukemia (AML) at Rush University Medical Group in Chicago, explains that the treatment of frail elderly patients with maintenance and continuous treatments requires special interventions and approaches. Even after achieving complete remission, patients with AML may relapse and maintenance treatments have been shown to benefit disease outcomes. Patients who have attained complete remission with azacitidine, at a reduced dose or treatment intensity, have been shown in clinical trials to have good outcomes.

Dr. Barry Skikne, an expert on acute myeloid leukemia (AML) discusses the importance of testing for AML mutations, which has become a key part of treating patients in order to understand the mechanisms of disease and mutation-driven treatment choices. IDH2 mutations is a determinant for FDA approved use of enasidenib for patients with relapsed or refractory AML. Ivosidenib has also been approved for AML patients with IDH1 mutations. It is very important to know the AML mutation at time of diagnosis or at time of relapse. Other mutations discussed are FLT3 mutations and approved therapy for relapsed or refractory AML treatment with gilteritinib and midostaurin. Daunorubicin and cytarabine as a single, fixed combination therapy is discussed which improves survival in patients with AML. Midostaurin has also been used in post-induction maintenance of AML patients. Oral azacitidine has more recently been used in patients with adverse risk AML after induction chemotherapy and complete remission for up to 1 year of treatment.  Recent newer agents venetoclax and gemtuzumab have also shown efficacy in AML relapsed patients.

In this video, acute myeloid leukemia (AML) expert Dr. Barry Skikne discusses leading clinical trials for older patients with AML and some of their outcomes. In an AML maintenance study, the HOVON trial using hypomethylating agents was designed to measure overall survival and relapse-free survival in elderly patients who had previous intensive chemotherapy. The study's importance is discussed comparing both relapse-free survival to disease-free survival in AML patients with findings suggesting benefits in relapse-free survival but not overall survival benefits. In a recent Oral Azacitidine Study in AML patients who continued on to maintenance therapy, significant improvement in overall survival and relapse-free survival was established. Moreover, oral azacitidine was found to be well tolerated with acceptable safety in clinical trial patients.  Other studies are evaluating combination therapies to improve AML patient outcomes and it is important for patients to discuss clinical trials with their providers.

Acute myeloid leukemia (AML) expert Dr. Jamile Shammo discusses recent advances in the  understanding of AML disease biology, which is changing the outcomes for patients. The importance of improved outcomes with combination-agent, and triple-agent therapy is becoming a new therapeutic area of importance in treating AML patients. Personalized patient care is becoming increasingly important in the future management of AML patients. The classical approach to AML treatment is induction, consolidation, and maintenance therapy. The relapsed patient is an area of focus in the future. Mutations are drivers of AML disease. Experts provide their own updates, based on their own clinical experience.