Usually, when you’re diagnosed with cancer, your doctor will perform tests to learn the stage. The stage tells the doctor how far the cancer has spread. This information can help your doctor decide which treatment is best for you, and predict your outlook.
Acute myeloid leukemia (AML) is different. It’s divided into subtypes based on how the cancer cells look, and what gene changes they have. Some types of AML are more aggressive than others and need different treatment.
The more your doctor knows about your AML — including its subtype — the easier it will be to find the right therapy for you.
Here are a few questions about AML subtypes and how they might affect your treatment. Use these questions to start a discussion with your doctor, and know what to expect in the months ahead.
What are the AML subtypes?
Doctors classify AML based on different features of its cells, including:
- how abnormal they look under a microscope
- if there are changes to chromosomes and genes
Your symptoms can vary based on the subtype you have. And each subtype responds differently to treatment.
For a detailed list of AML subtypes, see this article from the American Cancer Society.
How will you figure out my subtype?
To find out what subtype you have, your doctor will take samples of your blood and bone marrow. Your cells will then be looked at under a microscope. People with AML have fewer red blood cells and platelets, and a large number of immature blood cells.
Your samples will go to a lab, where the cells will be tested for certain markers on their surface. The cells will also be checked for changes — or mutations — to genes, including the FLT3 gene.
Knowing what type of AML you have will help your doctor find the right treatment for you.
What is the FLT3 gene mutation?
The FLT3 gene codes for a protein of the same name that helps white blood cells grow. In AML, a mutation in this gene leads to the production of too many abnormal blood cells.
What does having a gene mutation mean for my outlook?
Certain gene changes cause the cancer to behave more aggressively.
People with changes to the NPM1 or CEBPA genes tend to have a better outlook. Cancers with mutations in the FLT3, TP53, RUNX1, and ASXL1 genes are often more aggressive.
New drugs target some of these gene changes, and can help improve the outlook for people who have them.
What treatments will you recommend?
Chemotherapy is the standard treatment for most types of AML. You’ll get high doses of these medications to wipe out as many cancer cells as possible and put you into remission.
Targeted drugs are also available for certain gene mutations. These medications can increase your chances of going into remission.
The drug midostaurin (Rydapt) is an FLT3 inhibitor. It blocks FLT3 and other substances on the surface of cancer cells that help them grow. This medication is taken by mouth twice a day.
Adding midostaurin to chemotherapy significantly improves survival, research finds.
What if my treatment doesn’t work?
Compared to other types of this disease, AML with the FLT3 gene mutation is more likely to relapse. If your cancer does return, your doctor will discuss next steps with you.
One option is to have a stem cell transplant. Before a transplant, you’ll get very high doses of chemotherapy to kill off as many of the cancer cells in your bone marrow as possible.
Then you’ll get immature blood cells called stem cells from a healthy donor. These cells will multiply and replace the leukemia cells with healthy new blood cells.
What else can I do to manage AML?
Your doctor will focus on treating your cancer. You can concentrate on making lifestyle changes to help make you feel better during your treatment.
Both your cancer and the drugs you take to treat it can cause unpleasant side effects, such as:
- hair loss
- nausea and vomiting
- mouth sores
- appetite loss
- diarrhea or constipation
- increased risk of infections
- easy bruising or bleeding
- muscle or bone pain
Palliative care is a type of treatment that helps you manage symptoms while you’re going through cancer treatment. It can include medications and other types of therapies to improve your quality of life.
Take care of yourself during this time by eating nutritious foods, exercising, and getting enough sleep. If appetite loss makes it hard for you to eat, ask a dietitian for tips to help you get more nutrition — for example, by drinking enriched shakes or taking nutritional supplements.
You can also try complementary therapies to help you get through treatment, such as:
- guided imagery
- deep breathing
If you were recently diagnosed with AML, you probably need some time to process your cancer and understand how it’s going to affect your life. Get support from your medical team, friends, and family as you embark on this treatment journey.
Make sure you understand as much as possible about your cancer and its treatments. Don’t be afraid to ask for a second opinion if you’re unsure about the therapy your doctor has recommended.