What does it mean to have “favorable,” “intermediate,” or “adverse” risk AML, and how do those classifications affect treatment decisions? Hematologist-oncologist Dr. Anand Patel explains how in-depth test results can help doctors classify AML risk and guide care. Dr. Patel also defines induction and consolidation therapy, remission goals, and discusses when a stem cell transplant may be part of the treatment plan.
Dr. Anand A. Patel is the Medical Director of the Inpatient Leukemia Service at the University of Chicago Medical Center. Learn more about Dr. Patel.
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Transcript
Katherine Banwell:
How would you define low-risk and high-risk AML?
Dr. Anand Patel:
Great question. Really, what we utilize is the prognostic risk stratification tools, which, again, are informed by the genetic and chromosome abnormalities that are seen in the AML cells. Interestingly, how high or low someone’s white blood cell count is, in general, does not influence your prognostic risk stratification for AML.
And as I mentioned a bit earlier, the risk stratification tool that should be used is actually somewhat informed by what treatment you may recommend.
So, we know that these risk scores are not one size fit all. They are developed based on the therapies that someone is likely to receive. So, in patients that receive intensive chemotherapy for their AML, we use the ELN22 risk score, and their patients fall into these buckets of favorable risk, intermediate risk, or adverse risk.
The way I generally describe favorable risk AML is that the goal is to try and cure the leukemia with chemotherapy alone. Many patients can achieve that goal and do not need a stem cell transplant.
For intermediate and adverse risk AML, in general, the goal is to use chemotherapy to achieve a remission, and then for appropriate patients to try and then proceed with a stem cell transplant with the goal of cure.
Adverse risk AML, in particular, has a high risk of coming back even after a stem cell transplant is done. So, that is something that’s very important to discuss.
But ultimately, instead of staging, we really rely upon these risk stratification tools.
Katherine Banwell:
We’ve alluded to the fact that test results impact treatment choices. Would you define induction and consolidation therapy for our audience?
Dr. Anand Patel:
Absolutely So, induction and consolidation is terminology that is typically utilized for patients that ultimately receive what we would call intensive or high-dose chemotherapy.
Induction chemotherapy is the first kind of high-dose or intensive regimen that a patient receives, and the goal of that is to put the disease into a remission. Meaning, when we look for leukemia again with a bone marrow biopsy, we see that these blast cells have been reduced to under 5 percent, which is typically what defines a remission.
After induction, there may be anywhere from one to four additional rounds of chemotherapy that we refer to as consolidation. So, the goal there is to maintain the remission and to try and convert that remission into a cure. Now, for patients with favorable risk AML, again, the goal is to use induction and several cycles of consolidation to achieve a cure.
For those with intermediate and adverse risk AML, typically, we are looking for induction to put the disease in a remission, and for consolidation to maintain that remission, while the appropriate workup is being done and considerations are being made for a stem cell transplant. But this kind of terminology of induction and consolidation largely applies to the intensive chemotherapy approaches that we use for AML.