ASH Clinical News August 2016 | Page 40

TRAINING and EDUCATION Patient Education What Are the Risk Factors for AML? For most people who are diagnosed with AML, there are no obvious reasons why they developed the disease, but researchers have identified potential risk factors, including: • repeated exposure to the chemical benzene, which damages the DNA of normal marrow cells • certain genetic disorders such as Down syndrome, Fanconi anemia, Shwachman-Diamond syndrome, and Diamond-Blackfan syndrome • past chemotherapy or radiation treatments for other cancers remission (consolidation) and stem cell transplantation, either using a patient’s own cells (autologous transplant) or a donor’s cells (allogeneic transplant). Stem cell transplantation: This may be used with a second phase of chemotherapy. Clinical trials: Clinical trials can involve therapy with new drugs and new drug combinations or new approaches to stem cell transplantation. Taking part in a clinical trial may be the best treatment choice for some patients. Clinical trials are underway for patients at every treatment stage and for patients in remission. The choice of treatment and resulting outcomes depend on: • the AML subtype • progression of other blood cancers or disorders, including polycythemia vera, primary myelofibrosis, essential thrombocythemia, and myelodysplastic syndrome (MDS) • the results of cytogenetic analysis • use of chemotherapy in the past to treat another type of cancer What Are the Symptoms of AML? • the presence of MDS or another blood cancer Because of the under-production of normal bone marrow cells, it is common for patients with AML to tire more easily and have shortness of breath during normal physical activities. Other symptoms include: • whether the AML has reached the central nervous system • pale complexion due to anemia • signs of bleeding caused by a very low platelet count, including black-and-blue marks or bruises occurring for no reason or because of a minor injury, the appearance of pinhead-sized red spots on the skin (petechiae), or prolonged bleeding from minor cuts • mild fever • swollen gums • frequent minor infections • loss of appetite and weight loss • whether the AML has not responded to treatment or relapse has occurred • the presence of systemic infection at diagnosis • the patient’s age and general health Prognosis and Follow-Up Care After treatment, patients who are in remission and have completed post-remission (consolidation) therapy continue to be examined regularly by their doctors. Patients’ health, blood cell counts, and marrow should be monitored through careful periodic assessments. As time progresses, the length of time between assessments may grow, but assessments should continue indefinitely. Doctors should also discuss monitoring for long-term adverse effects or late effects of treatment. • discomfort in bones or joints • enlarged spleen • enlarged liver In addition, people with AML may experience the following conditions, which can be dangerous without treatment: • bleeding in the brain or lung • infection (especially if your body produces too few white cells known as neutrophils) • myeloid sarcoma (when a mass of AML cells can form a tumor elsewhere in the body) How Is AML Treated? 38 ASH Clinical News Cut out and give to a patient Doctors use several types of treatment for adults with AML, some at different stages. Chemotherapy or other drug therapies: Most patients with AML start chemotherapy right away. The standard treatment for AML includes high-dose chemotherapy with a cytarabine/anthracycline combination, followed by either one to four cycles of chemotherapy after August 2016