What is AML? | Survival Rates | Survival Rate Factors | Improving Prognosis | Support

“So you've gotten the shock that the bone marrow biopsy results are in, and now your life is turned upside down,” said Dr. Naveen Pemmaraju, an associate professor at MD Anderson Cancer Center in Houston.

Acute myeloid leukemia (AML) can be a frightening diagnosis. The word acute indicates a fast-growing, aggressive form of cancer. AML can be a difficult type of leukemia to treat. Some types of AML are more challenging to treat than others.

When diagnosed with a life-threatening illness like AML, you’ll want to know what the next five to 10 years of your life are going to look like. What treatments will you have? What is the prognosis? Is complete remission possible? Unfortunately with AML, these questions aren’t always easy to answer.

To get a better understanding of survival rates for AML and how the outlook has changed over the years, MyLeukemiaTeam interviewed Dr. Naveen Pemmaraju. Dr. Pemmaraju is an expert in multiple areas of acute and chronic leukemia. In addition to teaching at the MD Anderson Cancer Center, Dr. Pemmaraju treats people with cancer, conducts cancer research, and runs clinical trials.

What Is Acute Myeloid Leukemia?

Acute myeloid leukemia has many names, including acute myeloblastic leukemia, acute granulocytic leukemia, acute myelogenous leukemia, and acute nonlymphocytic leukemia. AML is a blood cancer that affects myeloid cells found in the bone marrow, the spongy tissue inside the bones. AML is one of four main types of leukemia, and it is the most common form of acute leukemia in adults.

A fast-growing form of leukemia, AML results in too many immature white blood cells (called myeloblasts) forming in a person’s bone marrow. Healthy myeloid blast cells mature into blood cells: red blood cells, platelets, or white blood cells. In AML, the leukemia cells crowd out the healthy blood cells and can spread to other areas of the body.

AML can occur at any age. However older adults are more likely to develop the disease than younger adults. At least 50 percent of people diagnosed with AML are over 65 years of age. In contrast, AML accounts for around 20 percent of childhood leukemia diagnoses.

Understanding Survival Rates for AML

“Approximately 20,000 people get AML and 10,000 people die every year from AML in the United States,” Dr. Pemmaraju said of AML. The good news: diagnostic and treatment advances over the last 50 to 60 years have brought about improved survival rates — plus greater potential for long-term remissions now more than ever. “There’s a lot of hope,” emphasized Dr. Pemmaraju.

What Is Relative Survival Rate?

Relative survival rate is the approximate percentage of people predicted to survive a life-threatening illness, like leukemia, over a distinct time period. It answers the question “Relative to people who do not have the disease, how long can a person with this illness expect to survive?”

Relative survival rates are not an exact science. They are approximations calculated using data from very large groups of people. Relative survival rates are based on the assumption that a person faces no other life-threatening risks, which may not be the reality.

What Is the Relative Survival Rate of Acute Myeloid Leukemia?

The relative five-year survival rate for leukemia in general has more than quadrupled, from 14 percent in the 1960s to almost 66 percent from 2009 to 2015. However, the five-year survival rate for AML from 2009 to 2015 was lower — 29.4 percent overall. For children and adolescents younger than 15 years old, the AML relative five-year survival rate is 68.7 percent.

What Factors Into the Survival Rate of AML?

A characteristic that helps predict disease outcome is called a “prognostic factor.” Various prognostic factors influence the leukemia treatment options and outlook for a person with AML. The subtype of AML you’re diagnosed with is also an important part of the equation.

Predicting the prognosis for AML is complex. “Your age, whether you underwent chemotherapy previously, your cancer history, your organ function, other diseases,” Dr. Pemmaraju said. “The combination of all of these things gives your treatment team an idea of your prognosis.”

Age

Treating AML in older people can be a challenge. The leukemic cells found in many older people with AML can be resistant to standard therapies. Older people with AML may not be able to tolerate toxic chemotherapy treatments or intensive treatment, such as radiation therapy and stem cell transplantation — both of which can be very hard on the body. Treatment for adults also differs from treatment for children with AML. “When it comes to outcomes and prognosis, age is a huge factor but not the only one,” explained Dr. Pemmaraju.

Acute Myeloid Leukemia Subtypes

“A breakthrough occurred when we realized that certain molecular subtypes exist,” Dr. Pemmaraju said. Determining a person’s AML subtype can inform important treatment options and decisions. AML subtype can also help approximate a person's prognosis. “Acute promyelocytic leukemia is a subtype considered to have a good prognosis or better outcomes,” Dr. Pemmaraju commented.

“We also have chromosomes and molecular features that identify high-risk leukemias,” Dr. Pemmarju explained. “Those features indicate patients who may have a poor prognosis as compared to their peers and, as a result, may have a different treatment paradigm.”

Medical History

There are several cancer-specific prognostic factors that influence a person’s AML prognosis.

• AML has a greater likelihood of being resistant to traditional AML therapies if it is linked to a prior blood cancer, such as myelodysplastic syndrome or myeloproliferative neoplasm (MPN), or to a prior cancer treatment.
• The better a person responds to initial treatment, the better the long-term outlook for their AML. Doctors expect cases of relapsed AML to have a poorer prognosis.
• If leukemic cells have spread to a person’s central nervous system, their AML will be harder to treat because chemotherapy drugs cannot reach the areas around the brain and spinal cord.

Comorbidities

When more than one health issue is present at the same time, the conditions are called comorbidities. Having a comorbidity can complicate AML treatment, as well as impact a person’s prognosis.

Older adults are more likely to have comorbidities, such as diabetes, high blood pressure, high cholesterol levels, heart disease, and a history of stroke or lung disease. Doctors must consider chronic conditions like cardiovascular disease, type 2 diabetes, and stroke when planning treatment regimens. Studies have shown that, among older adults with AML, people with a higher comorbidity burden tend to have less successful treatment responses and lower survival rates.

Other Factors

There are other factors that influence the prognosis of people with AML, including access to treatments and good communication with their health care team.

• Cost of care — Are the blood tests, treatments, medications, and recommended health care affordable in the short and long term?
• Access to care — Are the appropriate treatments and level of care available nearby?
• Treatment adherence — Are medications taken as prescribed? Are follow-up appointments attended to keep track of blood cell counts and monitor treatments?
• Education — Are the risk factors and side effects of treatment clearly understood? Is there open and frequent communication with the health care team?

Improving AML Prognosis

Diagnostic testing for AML has improved, which allows treatment to begin sooner. New and improved treatment options are also available. “In just the last two years,” said Dr. Pemmaraju, “seven or eight FDA approvals happened of novel oral drugs and targeted therapies. That means, for the first time for acute leukemia, we have a multitude of drugs. I can write a prescription for you to take outside of the doctor's office — at home!”

Several new drugs, taken alone or in combination with chemo treatments for AML, are also in development.

New treatments are becoming available on a regular basis and AML overall survival rates are improving. Despite the progress seen, there is still a lot to discover about AML treatments. “Clinical trials are still the number one recommendation for any patient with leukemia,” said Dr. Pemmaraju.

Finding Support for AML

MyLeukemiaTeam is a community of people 6,600 strong (and counting) who are living with leukemia or caring for someone who has it. More than 1,000 MyLeukemiaTeam members have AML. As part of MyLeukemiaTeam, you can expect to find a community of support.

It’s important to talk to your doctors about your AML, even about the tough questions. Have you had a conversation with your treatment team about your prognosis? If so, how did the conversation go? Do you have any advice on how to communicate openly with your doctor? Leave a comment below or join MyLeukemiaTeam to start a conversation.