He has returned to his normal life and to the tennis court. In acute myeloid leukemia, targeted therapies change prognosis

- I thought that the ailments would pass on their own, unfortunately, in the following days it got worse and worse. By the time I reached the second floor, I was so tired that I had to sit down and rest. I was unable to do anything, to focus on anything. But I didn't go to the doctor yet at that time. It wasn't until I heard from friends that I was looking worse and worse, that somehow my skin had turned yellow, that I went to the doctor. The doctor at the PCP took a look, listened, and immediately referred me to the hospital. And there her suspicions were confirmed. I was already lucky to begin with, because I ended up with a good doctor. Only, unfortunately, her suspicions were confirmed. Leukemia. Acute myeloid leukemia.

Most common in adults

Acute myeloid leukemia (AML), as Mr. Michael was diagnosed, is the most common acute leukemia in adults, accounting for about 80 percent of all cases of this type of cancer. Every year it is detected in about 1,500 people, which means that on average 4 people each day receive this diagnosis. These are mostly people over the age of 60, but there is an increasing incidence in younger people. AML mainly affects men.

An important role in the diagnosis of AML is played by genetic testing, which allows the identification of mutations that affect a patient's prognosis and determine the treatment process. One of the most common is a mutation in the FLT3 gene (30 percent of adult acute myeloid leukemia), and this is the subtype that Mr. Michael was diagnosed with. - Its presence means a very aggressive course of the disease and worsens the prognosis for the patient. If the patient is diagnosed too late and treatment is implemented late, this type of leukemia can kill within weeks, says Prof. Piotr Rzepecki, head of the Department of Internal Medicine and Leukemia. Department of Internal Diseases and Hematology at the Military Medical Institute - National Research Institute in Warsaw.

Ambiguous symptoms

Uncharacteristic symptoms cause patients to ignore them for a long time or attribute them to other conditions. After all, the symptoms of leukemia can be many. - The first symptoms, such as an elevated temperature, sometimes high, weakness, bone and joint pain, night sweats, patients blame on the flu or a cold. On the other hand, dizziness, shortness of breath that increases with exertion or poor tolerance of that exertion are mistaken for anemia. If, in addition to this, there are changes in the mouth, petechiae on the skin, bleeding from the nose or gastrointestinal tract, tinnitus, visual disturbances, respiratory failure, the patient should see a doctor as soon as possible. The important thing is that the symptoms of leukemia do not occur separately, but in a peculiar conglomerate. Here, timing is hugely important. Untreated acute myeloid leukemia can lead to death within two months," stresses Dr. Michal Sutkowski, president-elect of the College of Family Physicians in Poland.

Already the initial diagnosis says a lot

The primary test in AML is a blood count. If the result shows a lot of white blood cells, especially in combination with anemia and a low number of thrombocytes (platelets), such a picture suggests a neoplastic process of the hematopoietic system. But the patient may also have a normal white blood cell count, which does not exclude cancer. In that case, a morphology with smear is performed to assess the percentage of each type of white blood cells, as well as their structure and size. - Detection of a large number of blasts - abnormal precursors of hematopoietic cells - indicates acute myeloid leukemia, says Prof. Rzepecki. - The next step is already specialized testing, in the hematology department. Another essential test in the diagnosis of leukemia is a bone marrow biopsy to assess the number of cancer cells. If a patient has more than 20 percent abnormal cells, the next step is the so-called immunophenotyping, which is the precise determination of the type of these cells and thus the type of leukemia.

The drug that saves lives

Mr. Michael was first given chemotherapy and was being prepared for an allogeneic (from an unrelated donor) bone marrow transplant. The transplant was successful, but after three months the disease relapsed. And again chemotherapy plus an oral anticancer drug, but there were no results. - It was the worst period of my life," recalls Mr. Michael. - I was so exhausted that I couldn't walk. I was in bed all the time. Then one day came the news....

- There was a new drug registered to treat AML with the FLT3 subtype, and it saved my life. That was four years ago. Today I function normally, I'm back to tennis. I just go for check-ups, it's ok.

- When the disease returns after transplantation, the patient is given further treatment. As for these latest drugs, we can use them for now under RDTL, or Rescue Access to Medical Technologies, and under reimbursement, transplant patients don't yet have this option. And it would be good - and this applies specifically to patients with the FLT3 mutation - if we had this possibility under the drug program," says Prof. Rzepecki.

Necessary support system

- But it's not just access to modern therapy alone that is important, it's about creating a viable support system, one that guides the patient through the entire process, from diagnosis to treatment to life after the disease," points out Katarzyna Lisowska, president of the Per Humanus Foundation. - The patient must not be left alone when he has to make the most important decisions about his life. The zip code, or place of residence, cannot determine the patient's path. And unfortunately, this is the case today. If a patient already ends up in a center, then, one could say, he or she is lucky.