prof. Dr. Seçkin Çağrırgan: Stem cell transplantation offers hope in the treatment of acute myeloid leukemia

Acute myeloid leukemia (AML), a type of cancer also called blood cancer, is the most common type of leukemia in adults. AML, which constitutes 80 percent of acute leukemias in adults, is less common in children, but it constitutes 20 percent of childhood leukemias. Expressing that the incidence of acute myeloid leukemia increases with age, İzmir University of Economics Medicalpark Hospital Hematology Specialist Prof. Dr. Seçkin Çağırgan shared important information about the subjects that were curious on the occasion of April 21 Acute Myeloid Leukemia Awareness Day.


Acute myeloid leukemia, also called blood cancer, refers to the transformation of stem cells in the bone marrow, which are responsible for the production of blood cells, into cancer cells. Normal blood cells cannot be produced because cancer cells multiply uncontrollably and invade the bone marrow. Acute leukemia The clinical picture develops within weeks, at most a few months, as the cells multiply very rapidly. In chronic leukemia, the proliferation of leukemia cells is quite slow and the clinical picture generally develops over a long period of time, over years.

In the world, 5 new cases are seen per 100,000 population per year.

prof. Dr. Seçkin Çağırgan: “An important feature of leukemic stem cells that proliferate uncontrollably in acute myeloid leukemia is that they lose their differentiation feature and cannot form mature blood cells. As a result, the number of normal blood cells called white blood cells, red blood cells and platelets in the peripheral blood decreases rapidly. In chronic leukemias, the ability to differentiate is preserved, and as a result, the number of mature-appearing blood cells in the peripheral blood is usually increased rather than a decrease.


Stating that the incidence of acute myeloid leukemia in the world is at the level of 5 new cases per 100,000 population per year, Prof. Dr. Seçkin Çağırgan gave the following information: “Although there is not enough epidemiological data in our country, it can be said that the incidence is similar to the world-wide. In acute myeloid leukemia, leukemia cells called myeloblasts primarily proliferate in the bone marrow and prevent the production and production of normal blood cells. As a result, varying degrees of anemia develop.

Symptoms such as weakness, fatigue, palpitations, shortness of breath with exertion, and pallor occur due to anemia. As a result of a significant decrease in the number of white blood cells called neutrophils, one of the most important cells of the immune system, serious life-threatening infections may develop. Its manifestation may be a fever that is difficult to control and general malaise.


What is leukemia, why does it happen? Symptoms, types and treatment methods

Subcutaneous hemorrhages usually develop due to a significant decrease in the number of cells called platelets, which are among the main cells of the blood and play a role in blood coagulation and prevent bleeding, and as a result, bruising called ecchymosis, especially on the legs, and/or small, pinhead-sized bruises in the under-knee area. A red rash called petechiae is seen. Again, due to low platelet level, mucosal bleeding, mostly nose and gingival bleeding, vaginal bleeding, stomach and intestinal bleeding can be seen, and rarely brain bleeding may develop.

Acute myeloid leukemia is the most common type of leukemia in adults.

Underlining that acute myeloid leukemia is the most common type of acute leukemia in adults, Prof. Dr. Seçkin Çağrırgan: “While it constitutes 80 percent of acute leukemia seen in adults, it is less common in children and constitutes 20 percent of leukemias. Its incidence increases with age. While the incidence under the age of 65 is 1.2 cases per 100,000 each year, it reaches 12 cases per 100,000 over the age of 65.

It is slightly more common in men. Although an obvious cause of leukemia cannot be identified in the majority of patients, environmental or patient-related causes that are known to lead to the development of acute myeloid leukemia can be detected in some of the patients. Exposure to high doses of ionizing radiation or chemicals such as benzene, chemotherapy for another malignant disease may significantly increase the risk of developing acute myeloid. The risk of developing acute myeloid leukemia is high in patients with hematological diseases such as myelodysplastic syndrome, myeloproliferative disease, and aplastic anemia. Acute myeloid leukemia is also more common in genetic diseases such as Down syndrome than in the normal population.


Many different chromosomal abnormalities and mutations in certain genes can be detected in the leukemia cells of patients for whom a certain environmental or patient-related cause that can cause acute myeloid leukemia cannot be determined, which affects the blood production process and has been determined to have a role in the development of leukemia.

Catching a reduction in the number of initial target cells in treatment

prof. Dr. Seçkin Çağırgan: “The first step in treatment is an intensive chemotherapy application aimed at achieving remission, controlling the disease by reducing the number of leukemic cells, and allowing the formation of normal blood production in the bone marrow again. The response to this treatment is determined in the 3rd or 4th weeks. Complete remission can be achieved in approximately 70-80 percent of patients under 65 years of age with intensive induction chemotherapy. Unfortunately, these treatments cannot be applied to all patients over the age of 65.

The survival time of patients is increasing rapidly with new generation leukemia treatments

This type of intensive induction chemotherapy cannot be applied in frail elderly patients with unsuitable performance status, in patients with severe concomitant heart and kidney failure. In patients over 65 years of age, the response rate is lower, at the level of 40-60%. In patients whose disease is brought under control by achieving complete remission, the aim of the second step of treatment is consolidation treatments, which can be defined as consolidation treatments to prevent recurrence by destroying residual leukemia cells.


Another hope stem cell transplant in acute myeloid leukemia

During the diagnosis of acute myeloid leukemia, post-remission treatments are determined according to the prognostic characteristics determined according to the genetic abnormalities detected especially in the leukemic cells. Dr. Seçkin Çağırgan: “In patients in the good risk group, full recovery from the disease can be achieved only with high-dose chemotherapy applications. On the other hand, allogeneic hematopoietic stem cell transplantation from an HLA-matched relative or unrelated donor is the treatment that should be applied in patients with moderate and high risk and high risk of recurrence. Today, allogeneic stem cell transplantation can be applied up to the age of 75 in patients with suitable performance status.

Stating that there are treatment options with agents that are defined as hypomethylating agents and that patients can tolerate, in patients diagnosed with acute myeloid leukemia who are not suitable for intensive induction chemotherapy or who have a concomitant disease, Prof. Dr. Seçkin Çağırgan: “Some patients can respond, improve their quality of life and prolong their life span. Another very important aspect of treatment in chemotherapy and stem cell transplantation treatment processes and other treatment approaches is supportive treatments that will ensure the patient’s survival. Transfusions of blood products, treatments of developing infections and treatments of many complications that may develop in this process are of great importance.

Stating that there have been important developments in the treatment of acute myeloid leukemia in recent years, which have been reflected in the results and have positive effects on response rates and life span, Prof. Dr. Çağlayan added that positive results have started to be obtained with drugs developed especially for genetic mutations detected in leukemic cells, that studies in this area continue intensively and that better results will be achieved with less toxic treatments in the future.


Morale is very important in treatment.

Emphasizing that the most important point in the treatment processes is the moral strength of the patient, Prof. Dr. Seçkin Çağrırgan: “Staying with resistance against the disease, not lowering the sails, optimistic mood will positively affect the results and provide a better tolerance of the treatment. The most important task in this regard falls on the patient’s relatives and family members. Their positive support will facilitate the entire treatment process. During the treatment, it is important to provide a balanced and sufficient calorie diet. It is very important for the patient not to become physically depressed so that the patient can easily get through the intense chemotherapy.

During many periods of treatment, nutrition may become difficult for various reasons. Even in these periods, if necessary, it should be tried to consume suitable foods that will provide sufficient calories with the support of a dietitian. Until the treatments are completed, immunity will be significantly suppressed, especially in some periods, so hygiene and avoidance of inappropriate environments, isolation when necessary, will be very important, even vital.

Stating that although the diagnosis of acute myeloid leukemia is frightening, today, after a long and patient treatment process in centers with experienced teams, Prof. Dr. Seçkin Çağırgan concluded his words by saying that the developments show that we can be more hopeful about this disease in the near future.


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