Treating AML
- Many people may not know that actor Evan Handler, 61, battled acute myeloid leukemia in his 20s. But he pulled through, and despite all the challenges he faced, including an AML recurrence he was sure would end his life in his late 20s, he's alive today and doing great.
- The first phase of AML treatment is called induction, and this is typically when chemotherapy is given. The purpose of the chemo is to kill fast-growing cancer cells, but it also kills healthy cells because the drug is unable to tell the difference.
- Once chemo (or radiation treatment) is administered, the next step is a bone marrow transplant. SurvivorNet experts say that the bone marrow transplant is critical in the AML treatment process, seeing as a person's original bone marrow will be replaced by healthier bone marrow.
In the 90s, when he received his diagnosis, the disease was basically a death sentence (he was told he had a "very small" chance of survival), he told Science Goes to the Movies in an interview earlier this year.
Read MoreHowever, Handler, now 61, pulled through, and despite all the challenges he faced, including an AML recurrence he was sure would end his life in his late 20s, he's alive today and doing great.
He's even written two books: Time on Fire: My Comedy of Terrors, which details his fight with leukemia from age 24 to 29, and It's Only Temporary: The Good News and the Bad News of Being Alive, which is described during the interview as Handler's "subsequent effort to rejoin his regularly scheduled life already in progress."
Evan Handler's Cancer Diagnosis & Subsequent Battles
Evan Handler, in his early acting days, was building his career with Broadway performances.
During his Broadway days, he was scheduled to go on in place of another actor for a Neil Simon play, but Handler had the flu "a bug that I couldn't shake; a sore throat that didn't go away," he told Science Goes to the Movies.
He decided to see an ear, nose and throat doctor for his symptoms something many Broadway actors do, he explained.
"He (the doctor) was a little suspicious of some of my symptoms and sent me to a hematologist for blood tests," Handler explained.
Acute Myeloid Leukemia (AML) What Are the Symptoms?
According to SurvivorNet experts, acute myeloid leukemia symptoms can include:
- Fever
- Frequent infections
- Feeling tired or weak
- Easy bruising or bleeding
- Petechiae, which are blood spots under the skin
- Weight loss or loss of appetite
- Dull or sharp bone pain, usually in the legs and arms
- Pale skin
Handler's blood test revealed something he didn't expect: he was diagnosed with acute myeloid leukemia at just 24 years old.
"Ages 24 through 29 were pretty much chewed up and spit out with that," he said. "I did have a two-year remission. I went back and did another Neil Simon play on Broadway, and then the expected recurrence happened, which, you know, led me to conclude that Neil Simon plays were carcinogenic (having the potential to cause cancer)," Handler said with a laugh.
After his recurrence, Handler went into remission again and he's been cancer-free ever since (about three decades now).
Since he survived a diagnosis he thought would surely kill him, he's dedicated his life to being an activist for young cancer patients, working with organizations such as Stupid Cancer.
Treating AML
During his interview with Science Goes to the Movies, Evan Handler talks about the major AML treatment advancements that have been made since the 90s.
If you recall earlier, Handler said that AML was a "grim diagnosis" in 1996, and while it still isn't a cheerful one now, it's much more survivable than it was in the 90s.
"Most of that has to do with the fact that the actual treatment bone marrow transplantation has become the first line of treatment now, whereas then, it was still considered somewhat experimental and was only used in cases of recurrence," Handler explained.
What Acute Myeloid Leukemia (AML) Patients Should Expect During a Bone Marrow Transplant
The first phase of AML treatment is called induction, and this is typically when chemotherapy is given. The purpose of the chemo is to kill fast-growing cancer cells, but it also kills healthy cells because the drug is unable to tell the difference.
Once chemo (or radiation treatment) is administered, the next step is a bone marrow transplant. According to the latest National Comprehensive Cancer Network guidelines for treating AML, a bone marrow transplant isn't always used in the induction phase, but it is an option to "treat blasts that may have survived induction."
SurvivorNet experts told us that the bone marrow transplant is critical in the AML treatment process, seeing as a person's original bone marrow will be replaced by healthier bone marrow.
"It's a procedure which we've spent the last many weeks and months building up to, and your nurse while you're in the hospital will bring over basically a bag of blood, and it feels and looks like nothing more than a blood transfusion," Dr. Caitlin Costello, a hematologist and medical oncologist at UC San Diego Medical Center, previously told SurvivorNet.
During the transplant, patients will be connected to an IV, which will drip donor bone marrow into their system, and from there, the bone marrow will enter into the body through the bloodstream.
Patients will be in the hospital for two to four weeks after the transplant so they can be monitored while the bone marrow fully develops.
There may be side effects from the transfusion such as significant fatigue, nausea, and a weakened immune system, but that's what the medical team is there for.
For patients whose acute myeloid leukemia has returned like Evan Handler's did there are an increasing number of treatment options still available, Dr. Raoul Tibes, former director of the Clinical Leukemia Program at NYU Langone Health and now the executive medical director, global head of the Leukemia Strategy & Clinical Development at AstraZeneca, previously told SurvivorNet.
What Are the Options for Patients When Acute Myeloid Leukemia (AML) Returns?
Dr. Tibes explained that treatment options after relapse are often determined by when the disease recurs after initial remission. Patients who were in remission for a year or more before experiencing a recurrence, like Handler, are often put back on initial treatment and undergo a bone marrow (or stem cell) transplant, if possible.
For patients whose remission lasts less than a year, physicians will look for targeted therapies in order to determine molecular and genetic factors in the leukemia cells.
"We look for genetic and genomic changes in our leukemia patients that relapse," Dr. Tibes said. "Often we can compare them to their initial diagnosis and now we have a couple of medications available and we try to find medication that is specific for that molecular abnormality in leukemia cells."
Contributing: SurvivorNet staff reports
Learn more about SurvivorNet's rigorous medical review process.
