Pre-Existing Conditions That May Lead to sAML

In order to better understand secondary acute myeloid leukemia (sAML), it’s important to know more about what may cause it.

To start, there are two pre-existing conditions that may progress to sAML:

  1. Prior exposure to chemotherapy or radiotherapy. If you’ve received treatment in the past for certain cancers, or had high exposure to radiation, you may be at risk for developing sAML.1,2

    Cancer types that present a risk for sAML after initial treatment include:1

    • Breast cancer
    • Non-Hodgkin’s lymphoma
    • Hodgkin’s disease
    • Myeloma
    • Polycythemia
    • Ovarian cancer
    • Testicular cancer

    The risk of sAML due to previous radiation exposure depends on the amount of radiation that reached the bone marrow and for how long.2

  2. Certain abnormal blood cells or specific genetic mutations. If you’ve previously been diagnosed with another blood disorder, it’s possible your condition could progress to sAML – with or without treatment. There are also specific genetic mutations that have known links to sAML.3

The following are rare blood disorders that may progress to sAML – learning more about these conditions can help individuals have more robust conversations with their doctor.

Myeloproliferative Neoplasms

Myeloproliferative neoplasms (MPNs) refer to a group of rare blood disorders with a shared biology that are caused by abnormalities in the body’s stem cells. These abnormalities lead to an overproduction of mature and immature blood cells in the body.4 MPNs can initially cause few or even no symptoms in patients, which means that many people are undiagnosed while living with these diseases. MPNs may progress to AML, which makes them important conditions to monitor.5

There are three main types of MPNs: polycythemia vera, essential thrombocythemia and myelofibrosis. These blood disorders have common characteristics and may involve abnormal changes in certain genes. It’s important to give your doctor as much detail as possible about any symptoms you may be experiencing, as different MPNs have unique signs and symptoms, and treatment depends on the type of MPN you are diagnosed with.6

1. Polycythemia Vera

Polycythemia Vera (PV) is a type of blood disorder that causes the bone marrow to make too many red blood cells and thicken your blood. This can cause serious problems such as blood clots. With the right treatment and early detection, PV may be managed to help prevent or delay symptoms and complications.7 The overall incidence rate of PV in the United States is 0.7-2.6 per 100,000.8

Signs that PV may be progressing can include:6

  • Blood clot
  • Excessive sweating
  • Blurred visions or blind spots
  • Redness or purplish appearance of the skin
  • Bloating or an unexplained feeling of fullness

The abnormal growth of bone marrow cells associated with PV may lead to an AML diagnosis.7

2. Essential Thrombocythemia

Essential thrombocythemia (ET) is a rare blood disorder that occurs more often in people over the age of 50, and slightly more commonly in women. A diagnosis of ET means that the body is making too many platelets, which can affect the body’s ability to prevent or control excessive bleeding. Many who are diagnosed with ET only show minimal signs of disease; but if symptoms do occur, they can include throbbing or burning pain in the feet or hands, an enlarged spleen, thrombosis (abnormal clotting) and unexplained sweating. The causes of ET are largely unknown, and it isn’t typically passed down through families.6

The overall incidence rate of the disease in the United States is 0.6-2.5 per 100,000 cases per year.10 Two to five percent of people diagnosed with ET and PV will eventually progress to sAML 15 years after getting treatment.9

3. Myelofibrosis

Myelofibrosis is a rare type of bone marrow disorder that affects stem cells in the bone marrow, disrupting an individual’s normal production of blood cells and causing them to act abnormally. Myelofibrosis can also cause extensive scarring within the bone marrow. Over time, the scarred tissue and abnormal cells disrupt the bone marrow’s ability to produce red and white blood cells and platelets, which can result in symptoms such as fatigue, fever, frequent infections, pale skin, night sweats, an enlarged spleen and unexplained weight loss.11

Myelofibrosis is a rare condition, with incidence of 0.5-1.5 per 100,000 persons per year in the United States and a median age of 60-70 years.11,12 Some individuals living with myelofibrosis may not experience symptoms when first diagnosed – others may remain symptom-free for years. About 20 percent of patients with myelofibrosis will progress to sAML.11

While MPNs can present health risks, many people living with these conditions go on to live for many years following a diagnosis.6

Myelodysplastic Syndromes

Myelodysplastic syndromes (MDS) are a type of disorder that occurs from abnormal blood-forming cells in the bone marrow. MDS can progress into sAML in about one in three individuals living with the disease. There are several different types of MDS, based on how many types of blood cells are affected and other factors.13

To learn more about MDS and how it can progress to sAML, click here. You can also read about Pete’s journey with MDS and how he coped with his disease progression and treatment.

Aplastic Anemia

Aplastic anemia (AA) is caused when blood-forming stem cells in the bone marrow are damaged before they can become red blood cells, white blood cells, or platelets. AA symptoms can range from mild to severe, typically causing fatigue, easy bruising or bleeding, and infections that last a long time.14

The median age at diagnosis for AA varies from 25-60 years based on geographic location. It is a very rare disease, with an incidence rate of between 1.5 and 7 cases per million annually.15 AA has a range of potential causes – with some known factors including genes inherited from parents, certain medicines and exposure to environmental toxins.14

Approximately 15 percent of people diagnosed with AA go on to develop MDS or AML within 10 years. For people with genetic bone marrow failure disorders, the risk of progression is much higher.16

Bone Marrow Failure Syndromes

Bone marrow failure syndromes can result when the body either fails to produce sufficient quantities of blood cells or the cells it produces are abnormal. These syndromes can be caused by underlying inherited genetic conditions or exposure to toxins or certain viruses. Due to the distinct nature of these conditions, the diagnosis and care of these conditions can require a multidisciplinary team of specialists. Treatments can include monitoring of blood counts, supportive care, immunosuppression and/or bone marrow transplants.17

Advocating for yourself and speaking with an oncology social worker – if this is a comfortable approach for you – can help you when you make decisions about your treatment and care.6