One of the most effective treatments for AML is a transplant. Known as allogeneic hematopoieitic cell transplantation, this treatment infuses blood precursor cells, called hematopoietic cells, from a donor, so the patient can generate healthy bone marrow.
Prior to infusion, the patient generally goes through a “conditioning” chemotherapy regimen, which kills the cancer cells and suppresses the patient's immune system, so the donor stem cells can take hold, or engraft.
This conditioning regimen can be myeloablative or non-myeloablative. Myeloablative conditioning involves high-intensity chemotherapy or radiation that destroys the patient's bone marrow and suppresses their immune system. Due to the intensity of this regimen, there are serious potential side effects, especially for older or infirm patients.
Non-myeloablative , or reduced-intensity, conditioning is a newer treatment that uses lower doses of chemotherapy or radiation. This technique is also known as a mini-transplant. Because they are less toxic, mini-transplants can be a viable option for older or sicker patients. This conditioning does not completely eradicate the patient's bone marrow, but instead relies on "graft-vs-tumor effect," where donor cells attack any remaining or recurrent cancer cells.
After transplantation, patients can also be at risk of another complication known as graft versus host disease. This is occurs when a patient's immune system recognizes the donor cells as foreign and attacks them. Note: is this correct? Or is it the donor cells recognize the host as foreign and attack them?
Donors are chosen by finding as close a match as possible between the patient's and donor’s human leukocyte antigen (HLA), a protein on most cells in the body. A match can be between a relative of the patient (related matched donor) or by an unrelated donor (unrelated matched donor).
Our team is conducting studies to identify the best treatment options for older or more infirm patients with AML. If you are enrolled in a study, you can expect a series of clinical tests and surveys.
Breathing tests are a group of tests that measure how well your lungs are working. For example, they measure how much oxygen gets into your blood from your lungs. We would ask you to breathe in deeply and then out as hard and fast as you can into a tube. This would only happen once right after enrollment in the study.
We will review your medical records to collect information about your past medical history, status of your cancer, types of treatments offered to you, laboratory tests and imaging studies that are done as part of your treatment process.
Give us a blood sample to test iron levels, and to see if inflammation is present. This would only happen once right after enrollment in the study.
Provide a urine sample to check the level of protein in the urine which can give us a good evaluation of the function of your kidneys. This would only happen once right after enrollment in the study, preferably in the morning.
Throughout the two-year study period information is collected through eight surveys and other tests. Information from these questionnaires will be stored forever. You will receive a payment of $20.00 for each completed survey packet.
Surveys. We will ask you to fill out a survey at eight times – when you join the study, and approximately at 1, 3, 6, 9, 12, 18, and 24 months later. The surveys will be given to you at clinic visits, mailed to you, or can be read to you over the phone. It will take about 15 minutes to complete the survey. Surveys could be given a little earlier or later if you are sick, busy, or not free for other reasons. The survey asks about your medical history, your social activity, your physical functioning and lifestyle, and your treatment preferences and your anticipation of the chances of cure from cancer. We will also ask your physician to complete a survey about his/her preference for treating your cancer and his/her anticipation of the chances of your cure from cancer.
Up and Go Test. We will ask you to complete a physical mobility test that measures how long it takes you to stand up from a stand armchair, walk a distance of approximately 15 feet, turn, walk back to the chair, and sit down again. This test will only be done at enrollment, approximately 6 months after enrollment and approximately 24 months after enrollment.
Walk Test. We will ask you to complete a walking test where you will walk the distance of four meters three different times at each assessment time-point. This test takes three minutes to complete. This test will be done at the same time as survey collection.
Allogeneic hematopoietic stem cell transplantation: Donor cells are transplanted into a patient
Autologous hematopoietic stem cell transplantation: The patients' own cells are transplanted into the patient
Disease free survival (DFS) or Relapse free survival (RFS): Survival without evidence of disease or relapse
Graft-vs-host disease (GVHD): Occurs when donor cells attack patient's normal tissue. Can be chronic or acute and can cause issues in skin, gastrointestinal system, joints, liver, eyes, and other tissues
Graft-vs-tumor/ graft-vs-leukemia effect: When transplanted cells have an immune response to and kill a patient's cancer cells
Hematopoietic stem cells: Immature cells in the bone marrow or circulating blood that develop into blood cells such as white blood cells, red blood cells and platelets
Myeloablative conditioning: High dose chemotherapy or radiation used to kill cells in the bone marrow, allowing transplanted cells to engraft and produce health blood cells
Non-myeloablative chemotherapy: Lower dose chemotherapy or radiation that relies on donor cells killing remaining cancer cells (graft-vs-tumor, see below)
Non-relapse mortality (NRM): Death without relapse or recurrence of disease
Overall survival (OS): Survival from diagnosis or treatment regardless of disease progression