Acute myeloid leukemia, also known as acute myeloblastic leukemia, is the most common type of leukemia in adults, accounting for approximately 25% of all leukemias in the Western world. It is an aggressive leukemia where the percentage of survival decreases with age. In patients younger than 60 years, between 35 and 40% are cured; however, only 5% of older patients reach 5 years of life, and their median survival at diagnosis is 6.8 months. “There is the peculiarity that it has its median incidence after sixty years of age, especially between 65 and 70, and it is within oncohematology, and oncology in general, one of the most aggressive tumors that there is. The chances of cure go through the administration of intensive chemotherapy, which in a significant number of patients must be consolidated with a hematopoietic stem cell transplant or bone marrow transplant. It is a treatment that is not applicable to very elderly patients, which is paradoxically the highest percentage of patients”, explains Dr. Josefina Serrano , a specialist in the Hematology and Hemotherapy Service at the Reina Sofía University Hospital in Cordoba.
In the expert’s opinion, in the last decade much progress has been made in understanding the mechanisms of the disease and also in its diagnosis, and this has made it possible to expand useful therapeutic options in young patients. “The development of new-generation molecular and genetic techniques has meant that we know much more about the disease, how it develops, what biological peculiarities it presents, and thus drugs have emerged that have made a more personalized and targeted treatment possible ,” he says. .
Despite this, Lopez stresses the need to increase the therapeutic arsenal with innovations aimed at older patients with AML. “It is a very heterogeneous pathologythat it has many subtypes and that has allowed us to redefine the disease much better. There is a lack of therapeutic arsenal that is not so aggressive, that involves less toxicity and can be applied to more groups of patients”. Therefore, despite the advances in research, there are few relevant innovations that this disease has experienced in recent decades, being barely non-existent for the older profile not a candidate for transplantation or intensive chemotherapy.
Dr. Lopez is optimistic. “It has been possible to demonstrate the implication of a series of molecular alterations in intracellular pathways in the development of leukemia and to develop more targeted therapeutic strategies. That’s where personalized medicine goes. Target therapies or therapies directed at specific markers expressed by cells have been very important in this field and therapeutic innovations will continue to come from there”.
Some 160,000 people currently suffer from this disease worldwide
Due to these manifest needs for older patients, Dr. Lopez underlines the value of the research. “R+D+i is fundamental in the development of any scientific field and even more so in medicine”, she points out. From her point of view, the economic support for research “will revert to the development of better and more profitable ways of diagnosing and treating diseases.” Likewise, she emphasizes that “in addition to the economic means allocated to researchthat depend on the support of the authorities, it is necessary to be aware of the citizens and of the professionals themselves”. In this way, the expert defends research as a process in which basic research must be cared for and favor its translation into clinical practice with the ultimate goal of improving the quality of life of patients.
In addition to the challenges in clinical research, there are other improvements that have enriched the comprehensive approach to this disease. For Dr. Josefina Serrano, there have been improvements in support care and in the last two decades there have been very important improvements in bone marrow transplantation, both from a technical point of view and from a greater availability of donors.thanks to the increase in international registrations.
Keys to a complex and heterogeneous pathology
Under normal conditions, the bone marrow produces cells called myeloblasts that, after maturing, become granulocytes, cells responsible for defending the body against infection. In people suffering from acute myeloid leukemia, the cells of the myeloid lineage (myeloblasts) proliferate abnormally, progressively invading the bone marrow, interfering with the production of normal blood cells, which causes marrow failure and infiltrates extramedullary tissues. It is a very heterogeneous pathology, divided into several subtypes based on the genetic or molecular alteration that causes it. Despite advances in available treatments and care, the 5-year survival rate for patients remains approximately 28%. It tends to worsen rapidly, and because of age and comorbidities, not all patients are candidates for intensive chemotherapy. AML is the most common acute leukemia in the world. It is estimated that 160,000 people currently suffer from the disease worldwide, with an incidence rate of 103 new cases per 100,000 people , with a mean age of onset of 66 years.
