Acute myeloid leukemia (AML) is a cancer that affects your bone marrow. In AML, the bone marrow produces abnormal white blood cells, red blood cells, or platelets. White blood cells fight infections, red blood cells carry oxygen throughout the body, and platelets help blood clot.
Secondary AML is a subtype of this cancer that affects people:
- who had bone marrow cancer in the past
- who had chemotherapy or radiation treatment for another cancer
- who have blood disorders called myelodysplastic syndromes
- who have a problem with the bone marrow that causes it to make too many red blood cells, white blood cells, or platelets (myeloproliferative neoplasms)
Secondary AML can be harder to treat, but there are several options. Bring these questions along to your next appointment with your doctor. Discuss all of your options to make sure you know what to expect.
What are my treatment options?
Treatment for secondary AML is often the same as regular AML. If you were diagnosed with AML before, you may receive the same treatment again.
The main way to treat secondary AML is with chemotherapy. These powerful drugs kill cancer cells or stop them from dividing. They work on cancer all over your body.
Anthracycline drugs such as daunorubicin or idarubicin are often used for secondary AML. Your healthcare provider will inject chemotherapy drugs into a vein in your arm, under your skin, or into the fluid that surrounds your spinal cord. You can also take these drugs as pills.
An allogenic stem cell transplant is another primary treatment, and the one most likely to cure secondary AML. First, you’ll get very high doses of chemotherapy to kill as many cancer cells as possible. Afterward, you’ll get an infusion of healthy bone marrow cells from a healthy donor to replace the cells you’ve lost.
What are the possible risks?
Chemotherapy kills quick-dividing cells throughout your body. Cancer cells grow quickly, but so do hair cells, immune cells, and other types of healthy cells. Losing these cells can lead to side effects such as:
- hair loss
- mouth sores
- nausea and vomiting
- appetite loss
- diarrhea or constipation
- more infections than usual
- bruising or bleeding
The side effects you have depend on the chemotherapy drug you take, the dose, and how your body reacts to it. Side effects should go away once your treatment is finished. Talk to your doctor about how to manage side effects if you have them.
A stem cell transplant offers the best chance of curing secondary AML, but it can have serious side effects. Your body might see the donor’s cells as foreign and attack them. This is called graft-versus-host disease (GVHD).
GVHD can damage organs like your liver and lungs, and cause side effects like:
- muscle aches
- breathing problems
- yellowing of the skin and whites of the eyes (jaundice)
Your doctor will give you medication to help prevent GVHD.
Do I need a second opinion?
Many different subtypes of this cancer exist, so it’s important to get the right diagnosis before you start treatment. Secondary AML can be a very complex disease to manage.
It’s natural to want a second opinion. Your doctor shouldn’t be insulted if you ask for one. Many health insurance plans will pay for a second opinion. When you do choose a doctor to oversee your care, make sure they have experience treating your type of cancer, and that you feel comfortable with them.
What kind of follow-up will I need?
Secondary AML can — and often does — return after treatment. You’ll see your treatment team for regular follow-up visits and tests to catch it early if it comes back.
Let your doctor know about any new symptoms you’ve had. Your doctor can also help you manage any long-term side effects that you may have after your treatment.
What outlook can I expect?
Secondary AML doesn’t respond to treatment as well as primary AML. It’s harder to achieve remission, which means there is no evidence of cancer in your body. It’s also common for the cancer to come back after treatment. Your best chance of going into remission is by having a stem cell transplant.
What are my options if the treatment doesn’t work or my AML comes back?
If your treatment doesn’t work or your cancer comes back, your doctor can start you on a new drug or therapy. Researchers are always studying new treatments to improve the outlook for secondary AML. Some of these therapies work better than ones that are currently available.
One way to try out a new treatment before it’s available to everyone is to enroll in a clinical trial. Ask your doctor if any available studies are a good fit for your type of AML.
Secondary AML can be more complicated to treat than primary AML. But with stem cell transplants and new treatments under investigation, it’s possible to go into remission and stay that way long-term.