Name What to Know about Secondary AML

What to Know about Secondary AML

A diagnosis of secondary acute myeloid leukemia (sAML) can be overwhelming. Here are the basics about sAML that are important to understand.

sAML is a subtype of AML

AML is a blood cancer in which the bone marrow makes too many abnormal white blood cells called myeloblasts, red blood cells or platelets.¹ There are different types of AML, based on how mature the myeloblasts are at the time of diagnosis and how different they are from normal cells.¹

It can be difficult to pinpoint an exact cause of AML in each individual.² A diagnosis of sAML constitutes approximately 30% of AML cases.^3,4 sAML may be linked to specific preexisting conditions, like myelodysplastic syndromes (MDS), or to prior treatment for a malignant or non-malignant disease.⁵

There are Different Types of sAML

Therapy-related AML (t-AML): t-AML makes up approximately 4 to 10% of all AML cases, occurring as a result of prior treatment with chemotherapy or radiation for an unrelated cancer.^3-5 Cases of t-AML can develop two to ten years after completion of treatment for a previous cancer.^6-10
AML with myelodysplasia-related changes (AML-MRC): AML-MRC accounts for approximately 25% of AML cases, and it occurs when a person has abnormal bone marrow cells as a result of prior blood disorders.^3,5 In these cases, the bone marrow not only has an unusually high number of myeloblasts, but also possesses many other abnormal cells caused by a prior condition such as myelodysplastic syndromes (MDS) or myelodysplastic/myeloproliferative neoplasms (MPNs), where the bone marrow makes too many blood cells.^5,11

Your Subtype Matters

The type of sAML you have will inform your treatment plan, so it’s important to discuss subtype testing with your doctor.

Types of AML

The World Health Organization divides AML into several groups:¹²

AML with certain genetic abnormalities
AML with myelodysplasia-related changes (considered sAML)
AML related to previous chemotherapy or radiation (considered sAML)
AML not otherwise specified (including cases that don’t fall into one of the above groups)

Symptoms of sAML may include:¹

Fatigue
Fever
Weight loss or loss of appetite
Bleeding or bruising easily

¹ National Cancer Institute. Adult acute myeloid leukemia treatment (PDQ^®) – patient version. https://www.cancer.gov/types/leukemia/patient/adult-aml-treatment-pdq. Updated March 6, 2020. Accessed May 13, 2020.
² American Cancer Society. What causes acute myeloid leukemia (AML)? https://www.cancer.org/cancer/acute-myeloid-leukemia/causes-risks-prevention/what-causes.html. Updated August 21, 2018. Accessed September 16, 2020.
³ Nagel G, Weber D, Fromm E, et al. German Austrian AML Study Group (AMLSG). Epidemiological, genetic, and clinical characterization by age of newly diagnosed acute myeloid leukemia based on an academic population-based registry study (AMLSG BiO). Ann Hematol. 2017;96(12):1993-2003.
⁴ Leone G, Mele L, Pulsoni, A, et al. The incidence of secondary leukemias. Haematologica. 1999;84(10):937-945.
⁵ Ossenkoppele G, Montesinos P. Challenges in the diagnosis and treatment of secondary acute myeloid leukemia. Crit Rev Oncol Hematol. 2019;138:6-13.
⁶ Czader M, Orazi A. Therapy‐related myeloid neoplasms. Am J Clin Pathol. 2009;132(3):410‐425.
⁷ Vardiman JW, Thiele J, Arber DA, et al. The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood. 2009;114(5):937-951.
⁸ Bhatia S. Therapy‐related myelodysplasia and acute myeloid leukemia. Semin Oncol. 2013;40(6):666-675.
⁹ Godley LA, Larson RA. Therapy-related myeloid leukemia. Semin Oncol. 2008;35(4):418-429.
¹⁰ Offman J, Opelz G, Doehler B, et al. Defective DNA mismatch repair in acute myeloid leukemia/myelodysplastic syndrome after organ transplantation. Blood. 2004;104(3):822-828.
¹¹ National Cancer Institute. Chronic myelodysplastic/myeloproliferative neoplasms treatment (PDQ^®) – patient version. https://www.cancer.gov/types/myeloproliferative/patient/chronic-treatment-pdq. May 1, 2020. Accessed May 13, 2020.
¹² American Cancer Society. Acute myeloid leukemia (AML) subtypes and prognostic factors. https://www.cancer.org/cancer/acute-myeloid-leukemia/detection-diagnosis-staging/how-classified.html. Updated August 21, 2018. Accessed September 16, 2020.