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Hemato-Oncology-13-AML prognosis and role of transplant


Welcome to the thirteenth part of a series on Hemato-oncology.

Question: Dr. Chiragbhai, thank you for explaining about first type of “Blood Attack” i.e. Acute Myeloid Leukemia. So far we learned about risks, how to suspect, how to diagnose, and how to treat AML. What about prognosis? Is it curable?

Answer: This is an illness where cure rates used to be in range of 10-20% many years ago. Now it is about 50% average. It depends mainly on cytogenetics, and ability to tolerate most intensive therapy. In our experience, success rate is better than western average, because of majority of our patients are younger than in USA or Europe, and hence tolerate treatment better. In Western world, a large number of patients are over 60, and hence the overall results seem less there.

So, for a patient who can tolerate standard induction and consolidation therapy (i.e. generally below age 60 and with no major uncontrolled comorbidities), and has goodrisk cytogenetics, cure rate (being disease free forever) is about 70%. With intermediaterisk cytogenetics, it drops to 50%, and with poorrisk/high risk cytogenetics, it drops to 20%. Once again, patient has to be treated in a center with good experience and team, to ensure these results.

Stem Cell Transplant further improves cure rates by about 10% in each category. It is generally done after induction and one to two cycles of consolidation, or earlier in case of Allogeneic if a good matched donor is found earlier.

It is important to remember that option of Transplant cannot be offered to every patient, since results depend on age, comorbidities, fitness, cytogenetics, cost, ability for post transplant follow up and others. Many people think of transplant as a magical treatment which will cure every one. It is to be thought of as not a magical treatment, but an advance in treatment. As is true for many medical conditions and newer options, there are advantages and disadvantages.

Autologus transplant (using one’s own stem cells) is a good option for patients with good (except inv 16 and probably t 8;21) or intermediate risk cytogenetics. It is also better for patients with below noted limitations for Allogeneic transplant, however not for poor risk cytogenetics.Allogeneic transplant (using a donor’s stem cells) is for poor risk cytogenetics, and for young pts <30 yrs with intermediate cytogenetics and a good match.

Allogeneic transplant should not be offered to patient over age 40 (or up to very fit 50) or if there is a significant concern re follow up for at least six months (e.g. pt living far away and not willing to stay nearby hospital for six months). Also, it is possible only if there is a matched brother or sister. This is possible in only 25% patients. And since we do not have a registry in India, there is hardly any chance of finding a donor from outside family. In USA, there is a registry with over one crore volunteers.

Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA), 98243 12144, 98988 31496
Diplomate American Board of Oncology and Hematology. Ahmedabad.
Shyam Hem-Onc Clinic. 402 Galaxy, Near Shivranjani, Opp Jhansi ki Rani BRTS, Ahmedabad.