Acute Leukemia: 5 Things to Know

Victoria Stern, MA

Disclosures

December 13, 2019

3. New research points to previously unknown risk factors for acute leukemia.

Researchers have recently uncovered risk factors for AML and acute lymphocytic leukemia (ALL). A 2019 cohort study found that patients receiving chemotherapy for almost two dozen types of solid tumors had anywhere from a 1.5- to 10-fold greater risk of developing treatment-related AML or myelodysplastic syndrome (MDS), a rare type of blood cancer. For 15 of the solid tumors examined, the risk of developing treatment-related AML or MDS remained significant even 5 years after the initial diagnosis. Still, the risk remains low—of 700,612 adults who received chemotherapy for a solid tumor, only 0.23% (1619) were later diagnosed with MDS or AML.

Other recent research indicates that a child's risk of developing ALL may increase if the mother is obese. The analysis, which included more than 1.8 million infants, identified 2352 diagnosed with cancer and 747 with leukemia before the age of 14 years. Children born to mothers with a body mass index (BMI) of 40 kg/m2 or greater had a 57% higher risk of developing ALL and a 32% increased risk of developing any type of cancer compared with offspring of women in the normal BMI range.

4. Pediatric acute leukemia survivors may face infections later in life.

Infections remain a common complication for survivors of pediatric leukemia who receive hematopoietic stem cell transplantation (HSCT).

However, recent research shows that survivors of pediatric ALL and AML also have an increased risk of infections after chemotherapy. A 2019 retrospective study comparing infection rates in 2204 survivors of pediatric AML and ALL to 11,020 matched control subjects found that the risk of infection was highest within the first 5 years after treatment with chemotherapy as well as HSCT, and that the risk also remained elevated in the longer term.

Although the reasons infection risk remains high in the long term are unclear, some research suggests that chemotherapy can alter a child's immune system in long-lasting ways.

5. Acute leukemia of ambiguous lineage remains poorly defined.

Despite the evolution in clinicians' understanding of AML and ALL, much less is known about a third category of acute leukemia, the aptly named acute leukemia of ambiguous lineage (ALAL). Representing only 5% of cases of acute leukemia, ALAL cannot be classified as a myeloid or lymphoid leukemia. Some patients have no distinct lineage (undifferentiated), whereas others express more than one lineage (mixed phenotype).

Although no definitive guidelines exist for treating patients with ALAL, two studies provide some hints. Data from these analyses found that patients with ALAL tend to do better when treated with ALL-type protocols compared with AML or hybrid ALL/AML strategies. Specifically, one study reported a 5-year event-free survival of 65% in the ALL treatment group compared with 42% in the AML group and 47% in the hybrid group. The data to date lay the foundation for improving treatment protocols for patients with ALAL, but experts agree that more research is needed.

Victoria Stern, MA, is science journalist based in Los Angeles, California. Her work has also appeared in Scientific American MIND, Retraction Watch, and General Surgery News, and she is an editor for a new healthcare podcast, Tradeoffs.

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