Acute myeloid leukemia (AML) is a type of cancer that affects your bone marrow.
With 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’ve had:
- bone marrow cancer in the past
- chemotherapy or radiation treatment for another cancer
- blood disorders called myelodysplastic syndromes
- a bone marrow issue 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 still several options.
Consider bringing these questions along to your next appointment with your doctor and discuss all of your options to make sure you know what to expect.
Before 2017, there were no available treatments to treat secondary AML specifically. It was often treated the same as primary AML.
Here’s how secondary AML is currently treated:
Today, one of the only options approved for treating secondary AML is a combination of two chemotherapy drugs: daunorubicin and cytarabine, known as Vyxeos. This treatment is available as an infusion.
As with other types of chemotherapy, these powerful drugs kill cancer cells or stop them from dividing into multiple cells. They work on cancer all over your body.
After treatment is completed, your doctor will monitor your blood counts to determine whether you’ve achieved remission. Sometimes one or two low dosages of the drug are recommended to maintain remission.
The second drug approved for treating relapsed or refractory AML is a targeted therapy known as Idhifa. It’s prescribed for those who have an IDH2 gene mutation.
It works by inhibiting the IDH2 mutation and promoting the ability of young blood cells to mature and function normally.
This treatment is taken orally. Your doctor will monitor your blood counts before, during, and after treatment to check for side effects.
Stem cell transplant
A 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. Then you’ll get an infusion of healthy bone marrow cells from a healthy donor to replace the cells you’ve lost.
Treatment options for primary AML may also be used to treat secondary AML. That includes other types of chemotherapy drugs and targeted therapies. It’s less common to treat AML with radiation or surgery.
Researchers are also actively looking into more options for treating AML.
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.
Wiping out these healthy 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 experience will depend on
- the type of chemotherapy drug you take
- the dose
- how your body reacts to it
Talk with your doctor about how to manage side effects if you experience them during treatment. Side effects should go away once your treatment is finished.
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 lead to side effects like:
- muscle aches
- breathing problems
- yellowing of the skin and whites of the eyes (jaundice)
Your doctor can give you medication to help prevent GVHD.
Many different subtypes of this type of 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 cover the cost of a second opinion.
When choosing a doctor to oversee your care, make sure that they have experience treating your type of cancer and that you feel comfortable with them.
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 experience. Your doctor can also help you manage any long-term side effects that you may have after treatment.
Secondary AML doesn’t respond to treatment as well as primary AML. It’s harder to achieve remission, a state where no evidence of cancer in found 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.
If your treatment doesn’t work or your cancer comes back, your doctor can start you on a new drug or therapy.
Researchers are continuously studying new treatments to improve the outlook for secondary AML. Some of these therapies on the horizon may work better than those currently available.
One way to try out a new treatment before it’s widely available is to enroll in a clinical trial. Ask your doctor whether 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 combination chemotherapy drugs and stem cell transplants, as well as new treatments under investigation, it’s possible to achieve and maintain remission.
With secondary AML, it’s important to work with your doctor to manage and monitor your condition to improve your individual treatment outcomes.