'high-risk patients will relapse': actor nicki aycox's death from acute myeloid leukemia another example of much-needed treatments
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acute myeloid leukemia is a cancer of the blood and bone marrow, and the most common type of acute leukemia in adults. getty
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cancer cells are “smart” and always evolving and mutating, says dr. yan liu, phd, a leader in the field of blood cancer research out of feinberg school of medicine at northwestern university in chicago.
“most of the time, leukemia cancer cells are resistant to treatment, no matter the chemotherapy or targeted therapy,” he says. “that’s why after the treatment, the patient appears to be recovered. but there’s always a small population of leukemia stem cells still there, and most of the high-risk patients will relapse and tend to have reduced overall survival.”
his comments give some context to news of the death of “supernatural” actor nicki aycox at age 47. her sister-in-law made the announcement on facebook on nov. 17, noting that aycox “was definitely a fighter and everyone who knew her loved her.”
only 23 per cent of people with aml will survive five years after diagnosis
while the cause of death was not shared, the actor had been public about her diagnosis and treatment for acute myeloid leukemia (aml) in 2021. she became very ill and thought she had covid-19 until she ended up in hospital where tests confirmed leukemia. earlier this year, she posted on instagram that she was having treatments for aml again.
aml is a cancer of the blood and bone marrow, and the most common type of acute leukemia in adults. as an acute cancer, it gets worse fast if it is not treated, according to the national cancer institute.
only 23 per cent of people diagnosed with aml will live for at least five years after the diagnosis, the canadian cancer society says. it’s one of the rarer blood cancers, with 1,090 canadians diagnosed in 2016, according to the most recent statistics, and 1,184 canadians dying from the disease in 2017. although the exact cause of aml isn’t known, risk factors include certain genetic conditions like blood disorders, smoking and high doses of radiation.
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experts and patient advocates say the treatments and support for people diagnosed with aml have improved dramatically in the last 10 to 15 years, and there is hope.
in the liu laboratory, liu and his team have discovered a way to target and knock out leukemia stem cells without harming other healthy cells in the body.
“to cure leukemia, you have to target the leukemia stem cells. that’s our concept,” liu says. “you have to find a key regulator for the leukemia stem cell function that doesn’t affect normal stem cell function.”
previous research has pinpointed proteins known as flt3 and prl2 in fast-growing aml cells, but liu has identified exactly how the prl2 protein promotes aml cell proliferation and survival.
for the study, recently published in the journal blood, liu’s team blocked prl2 in mice that were transplanted with aml cells, showing that inhibiting the prl2 activity actually decreased the cancer and extended overall survival in the mice. further biochemical studies also demonstrated that prl2 increases the activity of the problematic flt3 protein as well in aml progression.
a therapy fit for clinical trials
the good news is that liu’s work has established another therapeutic milestone for aml patients: doctors could target prl2 by itself or combine the prl2 and ftl3 inhibitors for a combination therapy in case people develop resistance. his team is working with a chemist to develop the therapy for clinical trials in aml patients.
“the challenge for physicians right now is that after a few years of having a patient taking the inhibitor for some time, they will develop resistance,” he says. “leukemia cells develop new mutations to resist your drug, meaning that you always need additional targets to make the therapy more effective.”
for example, using a combined therapy like the ones his team is developing to knock out both prl2 and ftl3 proteins in aml cells, reduces the toxic load of the drugs since you’re using lower doses of different drugs.
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“you can reduce the toxic dose and then you can also potentially reduce the side-effects of the treatment so you can improve the life of leukemia patients,” he says of the pain, diarrhea, vomiting and fatigue that can come with treatment.
he also emphasizes the importance of ongoing tests and monitoring for those who go into remission in order to keep a constant watch on their health. heart disease, secondary cancers, and thyroid issues are also associated with aml.
but liu’s commitment to finding a cure goes beyond the lab.
“we want to give hope for patients and families,” he says. “we know you’re suffering, but we work very hard. we try to improve your life and help you live a longer and better life.”
nadine prevost, director of research and community support with the leukemia and lymphoma society of canada (llsc), is also encouraged by advancements in treatments and mitigating the side-effects. but she stresses the need for peer support and mental health services that help people going through what can be terrifying ups and downs of aml.
“cancer is not a linear experience,” she says. “people can have chemo and then they can have drug therapy and then they can relapse, and then they can have a stem cell transplant. and then if they become cancer-free with that, there’s another other grey zone.”
she’s referring to challenges that come in addition to debilitating fatigue and lack of appetite, like the pressures to return to their former life and be the person they were before aml.
“they’re not the same person and they have side-effects and they feel different — they feel that they’ve been through a trauma,” prevost says.
depression and “survivor guilt”
she also adds that not only is depression common among patients and those in remission, many also cope with “survivor guilt,” having spent time in cancer centres where others they’ve met have died. what is a complex disease to treat is also complex both mentally and emotionally.
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her organization is calling for mental health services to be part of the cancer care system to link people with professionals and get them the help they need to adapt to their “new normal.” the llsc has a video on what that “new normal” may look like.
she stresses the importance, too, for people with aml to connect with peers and the cancer community through the llsc and other networks.
“cancer is too big to understand when you haven’t been through it,” she explains. “it can change your perspective completely when you talk to someone who has been through it and is doing well today.”
karen hawthorne is a toronto-based writer.
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