An intense but potentially life-saving treatment aimed at eliminating leukaemia cells and achieving remission for a type of blood cancer that originates from bone marrow has seen success at Monash Health.
The significant milestone was recorded in a 5-year study that oversaw the treatment of 58 patients who had been newly diagnosed with Acute Myeloid Leukemia (AML).
Monash Health haematologist Dr Aditya Tedjaseputra, the first author of the paper, which was published in the Internal Medicine Journal, explained that AML is a rapidly progressing cancer.
‘AML is a type of blood cancer where the bone marrow produces too many abnormal, immature blood cells. Due to the cancer often progressing rapidly, it will usually require immediate treatment.’
Patients in the study received a short but intensive initial treatment known as ‘AML induction’.
An AML induction (or remission induction therapy) is the very first treatment a patient with newly diagnosed AML receives, with the primary objective of achieving remission or getting the cancer under control.
This may be given with a palliative intent, where the focus is maximising quality of life, or with the intent to cure. Typically, with cure as the ultimate goal, patients would be prescribed an ’intensive’ induction protocol, comprising high-dose chemotherapy, occasionally with the addition of a targeted therapy, depending on the disease’s mutational status.
‘Our recently published paper summarised our “first 50″ experience with such an approach, pleasingly with outcomes that benchmark very well against international standards,’ said Dr Tedjaseputra.
Dr Tedjaseputra, who is also a haematopathologist, noted that the treatment is challenging for patients and the treating team alike due to the high risk of emergent complications.
‘In our attempt to destroy the leukaemia cells, unfortunately, most of the residual normal blood cells will also be effectively abolished for several weeks.
‘As such, careful supportive care during this prolonged period of having low blood counts, such as preventing and treating infections and provision of transfusion, and a multidisciplinary treatment approach, such as attention to nutrition and proactive rehabilitation, will be required.
‘A patient can reasonably expect to stay for several weeks to complete this induction, hopefully emerging at the other end in a state of complete remission, from which we can then plan further curative consolidation therapy,’ Dr Tedjaseputra explained.
Monash Health’s ‘real world’ outcomes in terms of remission and survival rates were better than previously published trial results and commensurate with recently published outcomes from the Australasian Leukaemia and Lymphoma Group (ALLG) National Blood Cancer Registry.
Dr Tedjaseputra said the primary reasons for these good outcomes are twofold.
He said there are some technical reasons, such as the ‘favourable’ genetics some of the patients had presented. However, the team’s collaborative, detail-oriented approach to clinical care was also a major contributor.
‘This starts right from the bedside: our team would begin each patient’s journey with a comprehensive discussion on things to expect, potential risks and support that is available.
‘Having an open line of communication is key: our nurses, doctors, allied health staff and pharmacists talk to each other a lot in our care for these patients.
‘At a higher level, we also foster positive working relationships with other relevant specialties, particularly with Radiology, Infectious Diseases, the Emergency Department and Critical Care.
‘With so many “cogs in the wheel”, we involve these teams in our clinical meetings, and we help each other with our respective expertise,’ he said.
Between 2000 and 2018, Monash Health was unable to offer AML induction treatments, but the important service has again been established at Monash Medical Centre.
Dr Tedjaseputra said, based on national registry data, Monash Health has been among the top three healthcare institutions for new AML cases diagnosed and treated annually in recent years.
‘This is a great development for the community we care for at Monash Health,’ said Clinical Director of Monash Haematology Professor Jake Shortt.
‘With AML inductions again being available, our patients living with leukaemia have access to the best possible care closer to their doorstep.’
Haematology Clinical Nurse Consultant Donna Gairns, who works with the nurses at Ward 44 who are instrumental to the care of AML patients at Monash Health, said bringing this treatment in-house again meant that our patients no longer needed to travel to the city, often far from home, for this treatment.
‘I think it’s an amazing service, especially at a time when patients can suddenly become critically unwell, and it comes from just having a blood test at their GP. They are sent to the hospital that night and spend up to six weeks there. At least we can provide an expert service for patients and support them close to home.
‘Being an expert nurse in haematology cancers, my role is making sure that the patients’ treatments are on schedule, making sure they feel well supported, understanding everything that’s happening to them and also helping the families along that journey as well,’ she said.
Congratulations to the research and treatment team on your success in establishing this important treatment option for our patients!