Acute Myeloid Leukemia Prognosis: Acute Myeloid Leukemia (AML) is the second most common leukemia type in adults. AML is the term used to describe a group of hematopoietic neoplasms that are composed of cells involving the myeloid line of cellular development. It is a type of cancer that affects the bone marrow and blood. An acute myeloid leukemia prognosis is dependent on a patient’s disease characteristics and subtype.
What determines an Acute Myeloid Leukemia (AML) Prognosis?
Unlike other cancers that rely on the stage for a prognosis, the outlook for an AML patient is determined by diagnosing the cancer subtype and its characteristics. Knowing the subtype can be critical in determining outlook and best treatment
The two systems that are used to determine AML subtypes include:
French-America-British (FAB) classification: this system involves dividing AML into subtypes of M0 through M7, determining subtype based on the type of cells that develop into leukemia and by how mature these cells are. Although this method is useful, it doesn’t take into account many of the factors that affect prognosis such as prior blood disorders, age and/or gene mutations.
World Health Organization (WHO) classification: This method attempts to use factors that affect prognosis in order to classify AML and it divides AML into groups based on specific genetic abnormalities, medical history, and treatment history.
What are the prognostic factors for AML?
Besides knowing the sub-type of AML that one has, other factors are also involved in the prognosis of AML. These include:
- Chromosome abnormalities: There are both favorable and unfavorable abnormalities such as translocation of individual chromosomes or loss of part of some chromosomes.
- Gene Mutations: People with mutation in any of the FLT3, TP53, RUNX1 and ASXL1 genes are linked to worse prognosis, while leukemia cells with changes in the NPM1 and CEBPA genes tend to have better prognosis.
- Markers on the leukemia cells: If the leukemia cells have CD34 protein and/or the P-glycoprotein on the surface, they tend to have a worse prognosis.
- Age: Patients over the age of 60 tend to have a worse prognosis, while younger AML patients tend to have a better prognosis.
- White blood cell count: A high blood cell count around the time of diagnosis tends to lead to a worse prognosis.
- Prior blood disorder: History of blood disorders such as myelodysplastic syndrome can be linked to a worse prognosis.
- Treatment-related AML: AML that develops after treatment of a different cancer is linked to a worse prognosis.
- Infection: A blood infection when diagnosed is connected to a worse prognosis.
- Leukemia cells in the central nervous system: Having the leukemia spread to the brain and/or spinal cord can be linked to a worse prognosis.
- Status of AML after treatment: Depending on how the leukemia reacts to treatment can affect the long-term prognosis. Better prognosis is linked to a good initial response to treatment.