AML and Environmental Factors: What Patients Should Share With Their Care Team

Lisa Hatfield:

Dr. Khan, studies indicate that environmental factors like air pollution can impact AML disease characteristics and outcomes, as highlighted in your recent research. How can patients use this knowledge to have more informed discussions with their healthcare team about their individual risk factors and treatment planning?

Dr. Irum Khan:

Our understanding of external factors and how they influence leukemia characteristics is a field that is expanding, and we’re learning more and more. But I would say it’s a field that’s relatively in its infancy. There are certain risk factors that we absolutely know increase your risk of leukemia, and we’ve known about this for many, many years, and one of the big ones is prior chemotherapy or radiation to sites where you have bone marrow making blood, which is, you know, largely our central bones. So any kind of prior cancer that has been treated is a patient where we know that they’ve had an external exposure that has increased their risk of a blood cancer and specific genetic types of blood cancer that are enriched in the therapy-related leukemias.

So I think that my [ACT]IVATION tip for this question would be that certain aspects of your history must be shared with your oncologist, and sometimes in the midst of all the chaos, we forget that these are important things. But again, prior cancer, no matter when it was, and exposure to any kind of chemotherapy or radiation, and as well as industrial chemicals. I think would also be important, so occupation, discussing that with your oncologists, and let them decide if they think it’s relevant or not. Don’t hold back.

And then the other thing, another field that is, we’re learning is very, very important, is there are certain people that are born with what we call familial leukemia syndromes, or germline predispositions, meaning you are born with a copy of a gene that is different from normal, and that increases the risk of you getting cancer throughout the continuum of your life. And that may be, depending on what that gene is, it could be many different cancers, one of which could be a blood cancer. And, you know, I would say a decade ago, there were about two or three mutations that we thought about as existing in families and increasing the risk of leukemia. Now that list is ever-growing. I think it’s way north of 10, maybe 20.

And so trying to, if there’s any family history of any kind of cancer, and it doesn’t have to be a blood cancer, it could be any cancer, make sure you communicate that with your oncologist. Because there may be patterns there that obviously we would not expect you to be aware of, but the oncologist will be, and if they are not, they will get you into a cancer geneticist who can do that testing, which will be relevant to yourself, if it increases your risk of other cancers, and your family members, as they move forward through life and have different life experiences that may predispose them as well.

So I think regarding the activation tip, I think share any knowledge that you have about prior cancer, prior treatment, and family history. Regarding the effects of lived environment and exposures in the air, the soil, the food we eat, I think we’re only beginning to start to unpack that. Those are very difficult variables to study, as you can imagine, because it’s very difficult to study in isolation. But I think that it’s a very exciting field, and we’re definitely going to see more about that.

Lisa Hatfield:

Just for clarification, so there are two types of mutations that can be tested for, the germline mutations, which you may have that are familial, and then there’s also the possibility of having mutations within the cancer cells themselves. So those are two different types of testing, is that correct? And then the targeted therapies would address the mutations in the cancer cells?

Dr. Irum Khan:

Right, exactly. The ones you are born with are not routinely tested for, those are not necessarily the genes in the panel that we do for leukemia testing, which are very specific to acquired mutations that have developed in your bone marrow with age. This is a specific germline mutation test, it’s not being tested on your blood, it’s being tested on your skin, so non-blood tissue, to be like, this is an abnormal gene copy in all your cells and therefore was in you when you were an egg and is therefore everywhere. So completely different, and this would be in the purview of a cancer geneticist, requires its own insurance approval. So definitely that would be how that workup plays out, you see a geneticist, they see whether there’s a likelihood of having one of those, and then they do that testing.