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Karen Carlson, MD, PhD

When do leukemia patients need extra chemotherapy?

Milwaukee – October 26, 2018

Acute myeloid leukemia (AML) is a cancer of the bone marrow (the soft, inner part of bones where new blood cells are made) that moves quickly through the blood, affecting other areas of the body. For patients diagnosed with AML, intense chemotherapy is inevitable, requiring patients to stay in the hospital for up to six weeks.

The trouble with chemotherapy is that, instead of just killing the unhealthy cells that carry leukemia, it kills all cells. As a result, many patients risk exposure to serious side effects like infection, the need for additional platelet and red cell transfusions, and the chance of secondary cancers down the line.

In a recent article from Acta Haematologica, “Early Fluorescence in situ Hybridization Assessment during Acute Myeloid Leukemia Induction Chemotherapy,” a team of researchers sought a better way to determine which patients needed additional rounds of chemotherapy, and which did not—saving them the risk of adverse side effects. Blood Research Institute Assistant Investigator Karen Carlson, MD, PhD, and her team gave acute myeloid leukemia patients chemotherapy over the course of seven days. Fourteen days after the first dose, they took a mid-cycle bone marrow biopsy, which determined whether or not each patient needed a second cycle of chemo.

At the mid-cycle point, it was clear how to treat some patients. If there was no evidence of leukemia, Dr. Carlson said they waited for the bone marrow’s stem cells to kick-start and begin to make blood cells again. For the patients whose bodies still exhibited evidence of leukemia, Dr. Carlson and her fellow physicians recommended an additional round of chemo. The second round of chemotherapy did help these patients, with two-thirds going into remission. But, because of the extra treatment, they ran the risk of future complications.

Of the patients involved in this research, one-third did not fall into either of the categories above, thus requiring additional research to determine how to proceed. Dr. Carlson used a variety of research methodologies at their disposal and took a look at a couple of things:

  • Fluorescence in situ hybridization (FISH): big changes to a patient’s DNA as a result of leukemia
  • Karyotype: an at-a-glance picture of a patient’s chromosomes

Dr. Carlson and the team found was that patients with positive FISH results and a high-risk karyotype were less likely to go into remission after receiving chemotherapy. Patients with a good-risk karyotype and no sign of a FISH-positive disease were more likely to go into remission.

“My hope is that, when you’re in the middle ground and it’s kind of confusing to know how to advise people in terms of giving an additional cycle of chemotherapy or waiting, as we get the results back, maybe we will be able to start to incorporate that data and feel a little more confident in advising to go ahead with or hold off on chemotherapy,” Dr. Carlson said.

About the expert: Karen Carlson, MD, PhD, is an assistant investigator at the Blood Research Institute and assistant professor for the Department of Internal Medicine, Division of Hematology and Oncology at the Medical College of Wisconsin.

Authors

Karen-Sue Carlson, MD, PhD

Assistant Investigator
View Bio > Call: Fax: Email: karensue.carlson@bcw.edu
Karen-Sue Carlson, MD, PhD

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