Acute Myelogenous Leukemia (AML) Support Group
Acute myelogenous leukemia (AML), also known as acute myeloid leukemia, is a cancer of the myeloid line of blood cells. Patients with AML usually present with symptoms such as fatigue, bleeding, infection, prompting medical attention. An abnormal blood test reading will then result in further testing in a hospital with a hematologist to determine AML.
I think I may have given some bad info on stem cells, and I think this is the best way to correct it. I am on another list called Inspire (not nearly as good as Daily Strength but it does provide opportunities). Anyway, this participant named Mike seemed to really have a handle on it, and so I posed the question to him and this was his response. He is also high on the work they are doing at UPenn (UPenn anti-CD123 CAR AML) that might be something that some of you would want to look into as an alternative if you are at that point (most of us are not).
Anyway, here it is and I hope it does some benefit to all of you -- dave
By LS1C5
Reply 4407421 Inspire/Vidaza/August 22, 2013
Today at 9:21 am
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The cancer stem cell population is a fraction of a percent, but that is enough to cause relapse. Cancer stem cells have not been found (yet) in every cancer, but AML was one of the first cancers where they conclusively isolated the cancer stem cell (CSC) or leukemia stem cell (LSC) in the literature. Chemo kills off rapidly dividing cells which would be blasts / actual tumor cells. But cancer stem cells, like normal stem cells, do not rapidly divide and so they are insensitive to chemo. They, like normal stem cells, are also good at evading poisons and removing poisons. So when a treatment comes along that can kill off that cancer stem cell population, there is real chance for a cure.
It does not look like a UPenn anti-CD123 CAR AML trial is starting. I heard from (name withheld) mom that they had asked about it too for a friend and nothing is ready yet. Dr. June's team and others are looking at tandem CARs to get around off-target toxicity. They will chose two targets that are both expressed by the cancer cells and not healthy cells. In other words, for a cell to be targetted, it will have to express 2 out 2 targets.
I don't believe they have identified a leukemia stem cell for CLL and ALL. Therefore for the few lucky people who have benefitted from the anti-CD19 CAR therapies, their CAR T-cells have to stick around to kill off blasts because their bone marrow is probably still producing them in addition to trying to make normal B cells.
Mike
Anyway, here it is and I hope it does some benefit to all of you -- dave
By LS1C5
Reply 4407421 Inspire/Vidaza/August 22, 2013
Today at 9:21 am
Report post
The cancer stem cell population is a fraction of a percent, but that is enough to cause relapse. Cancer stem cells have not been found (yet) in every cancer, but AML was one of the first cancers where they conclusively isolated the cancer stem cell (CSC) or leukemia stem cell (LSC) in the literature. Chemo kills off rapidly dividing cells which would be blasts / actual tumor cells. But cancer stem cells, like normal stem cells, do not rapidly divide and so they are insensitive to chemo. They, like normal stem cells, are also good at evading poisons and removing poisons. So when a treatment comes along that can kill off that cancer stem cell population, there is real chance for a cure.
It does not look like a UPenn anti-CD123 CAR AML trial is starting. I heard from (name withheld) mom that they had asked about it too for a friend and nothing is ready yet. Dr. June's team and others are looking at tandem CARs to get around off-target toxicity. They will chose two targets that are both expressed by the cancer cells and not healthy cells. In other words, for a cell to be targetted, it will have to express 2 out 2 targets.
I don't believe they have identified a leukemia stem cell for CLL and ALL. Therefore for the few lucky people who have benefitted from the anti-CD19 CAR therapies, their CAR T-cells have to stick around to kill off blasts because their bone marrow is probably still producing them in addition to trying to make normal B cells.
Mike
This treatment seems like it's taking the place of the GVL effect. That would virtually eliminate the need for stem cell transplants, no? Unfortunately this treatment is in its infancy and the way research moves at a snail's pace this is probably a generation away from being a recognized treatment. But I truly believe the researchers think they have this disease surrounded and are real close to a true breakthrough, not just another drug that will give us a few months before the cancer finds its way around it.
I like to annoy my doctor by calling my treatment plan "our little science project". Well I hope somebody down in Philly gives whoever they have to a kick in the ass to get this science project started. We need all the lines in the water we can get and maybe someone will get a bite.
I will have to inquire next time I am at Penn.
Andrea
In my case my second onc (the one that saved my life) did not REALLY know either. He said -- "we think we see an 8-21 translocation but cannot be totally sure. But we will say that that qualifies you (you old dog) for some intensive chemo. Are you game?" Well, not it those exact words, but you get the idea.
So how does chemo work? Let's not call it a cure, it is not -- it is a way of prolonging life -- that is a better way to look at it. So, the way I look at it, I am given another ten years or so so that I can die of a heart attack or something else. If I lived long enough then I am sure that the AML would come back in some form, but why worry about that, after all, the heart attack is going to kill me!
My theory on it is that in fact the chemo HAS to have the power at least in some cases to either: (1) kill all of the mutant stem cells or (2) render them impotent so even if they are not dead they really cannot do any harm. These two alternatives have to be exhaustive -- there cannot be any others. Now Mike did not say that chemo could NOT kill the stem cells -- he said that they are highly resistant to that. My onc said you better be thankful for that since if that were not the case it would have killed them all and you along with it. You cannot survive without blood cell producing stem cells. So all of them mare resistant and it is a matter of chance whether it does the trick. With some cases (e.g., T(8;21)) the chances of a hit seem to be higher, perhaps because these ugly mutants are just not as tough or clever as some others.
If anyone can improve on these theories, please do so, and lets pray for our fellow fighters in Phily. Hey, I grew up across the river in the Beverly/Edgewater Park/Burlington area, so that's back home to me. Take care -- dave