Talk:Acute myeloid leukemia/Archive 1

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Current, evidence-based results from reviews published by Cochrane hematology were added to this article. Cochrane haematology is part of the Cochrane-Wikipedia-Partnership. — Preceding unsigned comment added by Swantjekle (talk • contribs) 15:42, 8 July 2020 (UTC)

What about adding in stats and prognosis info with the FAB type?

The below info needs to be verified befor being placed in the artical.

FAB subtype, % of adult AML patients, Prognosis compared to average for AML

M0, 5%, Worse

M1, 15%, Average

M2, 25%, Better

M3, 10%, Best

M4, 20%, Average

M4 eos, 5%, Better

M5, 10%, Average

M6, 5%, Worse

M7, 5%, Worse

Please, PLEASE ban 195.93.21.103 from editing wiki articles.

For more examples of his blatant vandalism, look at his contribs: http://en.wikipedia.org/w/index.php?title=Special:Contributions&target=195.93.21.103

IronPhoenix 16:31, 8 October 2006 (UTC)

... comments on the page? It's coming together. Any areas which need to be addressed, reworked, improved, etc? MastCell 19:05, 20 August 2006 (UTC)

Looks good! More references would be nice though. Btw. for some more general feedback on articles (style, readability, etc.) you can also put them on peer review and I think this article with more references would make a nice featured article candidate. --WS 20:09, 20 August 2006 (UTC)

I'm not sure how the editing end of Wiki works so please forgive my breaking protocol... I deleted something from the genetics section of this page that said that first-degree relatives of those with AML are three times more likely to develop AML. I deleted it because I do not think that is true. I do not have a study to reference this (not my field, so I wouldn't even begin to comb through the studies) but I did I talk to my step father about it and he was a hematologist for 30 years. My dad died of AML and I am doing a family medical history which is why I came across this page. I spoke up about this because I couldn't let it slide that people would be thinking they are at increased risk for AML when it's very likely that they are not. — Preceding unsigned comment added by 207.47.252.30 (talk) 17:19, 18 August 2014 (UTC)

I'll go ahead and list the article for peer review - I've tried to more fully reference it as well. MastCell 21:08, 21 August 2006 (UTC)

I was wondering if it would be a good idea to add names of people (known for other things) that had a history of AML. I know one which might be notable because the person fully recovered from it after one publicly known relapse (Ken Watanabe). I'm sure it would add to the integrity of the article. I see other medical articles that name people as well so I don't see a potential problem.--Hyokano 09:00, 18 September 2006 (UTC)

I think this would be OK in principle; my fear is that it will turn into a laundry list of people without adding much to the article (this has happened at Non-Hodgkin lymphoma, where most of the recent edits involve adding "prominent NHL patients" rather than improving the text of the article). But if you want to work on compiling a list, we can give it a shot and see how it looks. MastCell 18:13, 18 September 2006 (UTC)

== Etymology ==

This link gives the etymolgy: [1] Rintrah 11:37, 26 September 2006 (UTC)

This article somehow got through FAC and peer review without anyone pointing out that it doesn't conform to the layout at WP:MEDMOS; History really should be at the end. It also got through FAC with few PMIDs and without a correct bibliographic style on the books: I tried to add that info, but I'm not sure the ISBNs are correct, as the info I found at bn.com and amazon.com didn't seem to fit - please check the ISBNs I added. The books which are referred to more than once in footnotes should have complete entries in the References section. Sandy 05:18, 8 October 2006 (UTC)

I've added complete references for both books cited in the Reference section, and am working my way through the footnotes as well. The ISBNs appear to be correct. Fvasconcellos 14:16, 8 October 2006 (UTC)

Actually, the issue of layout did come up during peer review and the FAC process. My understanding is that the layout guidelines are suggestions. In most textbook chapters, the history of a disease is described first; hence I left it up front. However, it's not a big deal, so if you (or someone else) wanted to move the history down to the bottom, be my guest. MastCell 16:49, 8 October 2006 (UTC)

Not a decision I want to make alone :-) I believe the WP:MEDMOS guidelines make much better sense for an encylopedia largely accessed by laypersons, with an audience different than that of a medical textbook. On a separate note, I see the References have been switched back to Further Reading, when they are actually the textbooks used as References to back up the inline citations used in Footnotes (Notes). It's not necessary to repeat the full book info for every entry in Notes. They can look like this (with the full book listed in References - Further reading should be reserved for books *not* used as references; what is there now is incorrect):

1. Abeloff, Martin et al. (2004). Clinical Oncology, 3rd. edition, St. Louis, Mo.: Elsevier Churchill Livingstone, p. 2834. ISBN 0443066299.
2. Abeloff, Martin et al. (2004), pp. 2831–32.
3. Abeloff, Martin et al. (2004), p. 2828.
4. Abeloff, Martin et al. (2004), p. 2834.

I realize these are small points, but it's hard to get subsequent featured article candidates to follow guidelines when they can point to a current FA which does not. It would be helpful if such a quality article would follow WP:MEDMOS and WP:LAYOUT, by moving History to the bottom and following the conventions of Notes, References and Further reading (a section which should not be listed in this article, as there is none currently). I'm sorry I was traveling during the FAC, or I would have raised these points then. Sandy 17:55, 8 October 2006 (UTC)

With the exception of moving the History section down, I went ahead and made the changes above so the article would conform with Notes, References and Further reading: with the article on the main page, it would help future FACs to see the section headings conforming to guidelines. I hope this doesn't ruffle any feathers :-) Sandy 18:21, 8 October 2006 (UTC)

Good work. I may have gotten a bit carried away with the references :) Fvasconcellos 18:22, 8 October 2006 (UTC)

Whew, glad you like it: it's so important when it's on the main page to guide future editors :-) Should the other textbooks mentioned in Notes be listed also in References, even though they are used only once? I don't know how important those books are to the overall article. Sandy 18:28, 8 October 2006 (UTC)

I wouldn't think so. WP:MEDMOS defines "References" as "...sources used as background to a whole topic" (emphasis mine - though you've probably read this already). I don't think this applies to the other textbooks cited; as you pointed out, they're only cited once, and to support specific information provided in specific sections of the article. Fvasconcellos 18:44, 8 October 2006 (UTC)

That's what I thought: just checking. Sandy 18:50, 8 October 2006 (UTC)

to warn patients to seek help from a professional, like this one from netdoctor.co.uk:

The materials in this web site are in no way intended to replace the professional medical care, advice, diagnosis or treatment of a doctor. The web site does not have answers to all problems. Answers to specific problems may not apply to everyone. If you notice medical symptoms or feel ill, you should consult your doctor

They already do. Scroll down to the bottom of the page and you'll see a link to our General disclaimer. The medical disclaimer is prominently mentioned on that page. GeeJo ^(t)⁄_(c) • 13:46, 8 October 2006 (UTC)

Specifically addressed at WP:MEDMOS. Sandy 17:57, 8 October 2006 (UTC)

I wonder whether the peer-review process included a hematologist--there are a number of omissions from the article compared with "traditional" AML articles found elsewhere.--Dr.michael.benjamin 21:12, 19 February 2007 (UTC)

Wikipedia "peer review" is not like medical/scientific peer review - it's a matter of other editors looking at the article, most of whom do not have specialized knowledge of the subject in question. Which areas do you think could use beefing up? MastCell 21:36, 19 February 2007 (UTC)

Why isn't Acute myeloblastic leukemia already a redirect to this page? Am I missing something critical here? WhatamIdoing 22:27, 3 December 2007 (UTC)

Acute myeloblastic leukemia is a form of AML caused by Myeloblasts, precursors of granulocytes. Since AML also has monocytic, erythroid and megacarioblastic forms, I suspect the note under "Pathophysiology" "The malignant cell in AML is the myeloblast." to be wrong. Can someone confirm this, and change the Pathophysiology section to include all cell types involved in AML, including monocytic, erythroid and megacariocytic precursors? Perencake (talk) 13:49, 25 July 2011 (UTC)

It ties up the earlier comment about 70-80% of patients able to achieve a remission - the reader may be wondering what happened to the other 20-30%. Also early relapse should be mentioned. And also the fact that most hospitals will not do a stem cell transplant unless the patient is in remission - possibly after a relapse. 75.83.178.154 (talk) 13:53, 27 July 2008 (UTC)

"Refractory" AML -- refractory anything is just med-speak for "failed treatment". If the reader interprets "70-80% of patients achieve remission" as meaning "20-30% do not achieve remission", then the reader exactly understands the situation, without needing to introduce another vocabulary word. WhatamIdoing (talk) 23:03, 27 July 2008 (UTC)

I take the point, though - the article could go into more depth on salvage treatments for patients who don't respond to initial induction, as well as the implications for prognosis. There is a clear link between time to relapse and likelihood of responding to salvage chemo, though I need to pull up refs for it. Finally, it is true that stem cell transplantation in patients who are not in remission has a low success rate and many centers will decline to perform it on that basis. Let me look into adding these things. MastCell ^Talk 21:08, 28 July 2008 (UTC)

Refractory AML treatment options for Children are available at St Jude in what is named, "NK Cell - Haplo Transplant" Haplo means that the Child receives the NK (Natural Killer) cells from one of the two parents; the one who has MORE NK cells, that the Child does not have. These are Clinical Trials. http://clinicaltrials.gov/show/NCT00187096 MrJones (talk) 15:21, 19 October 2011 (UTC)

I think this is an excellent article, but like so many of the kind, I believe it is focused a little too heavily on the professional readership. In the section on treatments, for instance, I would expect a little more information on the (side) effects of treatment. The 1 month of hospital stay to (among other things) recover from treatment sounds ominous, and the average reader (e.g. myself) would certainly like to know a bit more there. Leukemia treatments are famed to be extremely high-dose/aggressive, and I'm missing information on that means for the individual patient. What do others think? Audionaut (talk) 14:34, 20 February 2009 (UTC)

If "myeloleukemia" is a synonym of AML, even if deprecated, I suggest mentioning it as such by name here, so it is picked up more easily in searches. If it is not a synonym, please forgive the suggestion. Thomas.Hedden (talk) 01:50, 11 May 2009 (UTC)

More information on side effects of treatment to include the bone marrow transplant would be helpful to me. I am post transplant AML. (Randy Hunter) —Preceding unsigned comment added by 76.110.68.103 (talk) 15:27, 12 November 2009 (UTC)

I fell this page is a little limited for FA status

• The page has a lack of images. Picture of the classic skin finding would be helpful. Images of drugs used to treat this condition.
• The discuss of causes could be expanded. How much for example does ionizing radiation effect the rates of AML.
• Some potentially controversial points are not referenced "The first clue to a diagnosis of AML is typically an abnormal result on a complete blood count." Is this truely more common than a person presenting with symptoms? PMID 15973668
• Wondering if it should follow Wikipedia:Manual of Style (medicine-related articles) more.
• Points like this also need to be refed "These differences may be due to population genetics, environmental factors, or a combination of the two."
• No comments about "Tumor lysis syndrome"

--Doc James (talk · contribs · email) 03:38, 29 May 2009 (UTC)

Those are all good suggestions. It's been on my list for awhile to update this article - it's a bit dated in terms of its handling of newer prognostic items (FLT3 internal tandem duplications, NPM/CBF mutations, risk stratification in patients with normal cytogenetics) and also doesn't spend much time on newer drugs (clofarabine probably being the most notable, though there should probably be some mention of recent results with azacytidine/gemtuzumab).

Images are great, but a bit hard to come by. We have some photos at our article on Sweet syndrome which we could consider using here. I agree with your point about symptoms of AML - I think (if I in fact wrote the sentence in question) that the intended meaning was that blood tests were the first clue that AML (as opposed to some other condition) was to blame for the various symptoms of fatigue, easy bruising, anemia, etc. Certainly most patients present with symptoms rather than being picked up asymptomatically on screening CBCs, so I agree with you that we should clarify. Your reference is a good one.

It would be worth mentioning tumor lysis syndrome. In practice this is fairly uncommon with AML, but that's probably because of the widespread use of prophylactic measures and the use of hydroxyurea or leukapheresis to reduce leukemic burden before initiating chemotherapy. If you want to take a shot at this, I'd be happy to help out - right now I'm pretty limited and don't think I have the time needed for a serious update and overhaul, but I agree that one may be in order. MastCell ^Talk 17:24, 29 May 2009 (UTC)

Sure Will work on it once I get home in a couple of weeks.--Doc James (talk · contribs · email) 14:33, 7 July 2009 (UTC)

I have included a section about immunotherapy for patients in the post-consolidation phase of AML, and specifically about treatment with interleukin-2 and histamine dihydrochloride. This combination therapy is approved by the EMEA and the European Commission, and is also available in most other countries (not the US).Urbano3 (talk) 12:42, 24 November 2009 (UTC)

Could you demonstrate that Ceplene is being used in practice? I cannot find any evidence of it. JFW | T@lk 20:59, 24 November 2009 (UTC)

Ceplene was approved by the EU late last year, and although the drug appears not yet to be widely used it has been available via a named patient program in Europe and in most other countries (except the US) since July this year (according to the IDIS homepage). In my view it is not logical that the AML article (which is otherwise excellent) mentions several investigational strategies for relapsed AML, none of which have been approved by any regulatory agency, but does not include even a sentence about an approved compound for relapse protection. (Urbano 3, 25 November 2009 (UTC)

I have re-inserted the section about post-consolidation therapy.Urbano3 (talk) 21:07, 25 November 2009 (UTC)

Someone has included that HDC/IL-2 reduces the relapse rate "by 14%". I have removed this figure, first since it is not correct, and second since the efficacy of other treatments is usually not presented in terms of percent improvement. The actual figures (according to the EMEA), is a >50% increase of maintained CR1 in all patients (ages 18-84), and a >75% increase of maintained CR1 in patients below the age of 60. Urbano3 (talk) 14:57, 26 November 2009 (UTC)

Why is it not correct? It derives directly from the article. You are talking about relative risk, which you can include if you wish. Also, would you prefer the number needed to treat?

Please edit consistently from one account, rather than using an IP as well as your login. JFW | T@lk 23:21, 26 November 2009 (UTC)

Sorry for not being consistent with the signatures, I am a newcomer on Wiki. I have included the relative risk, but I still think that figures like these are best avoided.Urbano3 (talk) 13:02, 27 November 2009 (UTC)

I disagree. Relative risk is interesting for the researcher, absolute risk is more interesting for the patient. A person may reduce the risk of relapse by 14% but even those who do not benefit will be at risk of side effects, e.g. thyroid autoimmunity from the IL-2.

Could you now please demonstrate to me that HDC/IL2 is actually used "in the real world" in AML patients not being considered for transplant? JFW | T@lk 11:58, 29 November 2009 (UTC)

JLW: I will answer your three points to the best of my knowledge. Your first comment about relative vs. absolute risk is valid, and I am satisfied with the current phrasing on the article page. Your second point concerns side-effects. HDC is used together with very low doses of IL-2 (approximately 1 million units sq BID, as opposed to the approved regimen in e.g. renal cell carcinoma of 18 million units per meter square by iv infusion). Side-effects such as autoimmune thyreoiditis and capillary leak do indeed occur with higher doses of IL-2, but not with these low or even ultra-low doses of IL-2. An abstract from the 2008 EHA conference (Brune et al., 2008) reported no difference in the quality of life (using the EORTC QLC 30 instrument) of treated and untreated AML in the phase III trial, thus underscoring that HDC/IL-2 seems to be a relatively non-toxic regimen. I have no information regarding your third point about the current use of HDC/IL-2, only that the drug is approved in Europe and available in most other countries. Urbano3 (talk) 14:48, 30 November 2009 (UTC)

From year's ASH meeting, the oral presentation on Vereloxin (Sunesis) seem like a home run. Any comments? —Preceding unsigned comment added by 64.201.225.137 (talk) 20:51, 12 December 2009 (UTC)

We should at least start voreloxin with details and refs. Final results of a phase II study of voreloxin in women with platinum-resistant ovarian cancer. looks encouraging. - Rod57 (talk) 03:07, 16 December 2012 (UTC)

If my writing has been disputed then put verification sign....OK....???--222.67.217.95 (talk) 03:06, 12 February 2010 (UTC)

You must be clearer about which edit you are referring to. JFW | T@lk 10:58, 26 September 2010 (UTC)

This edit seems to suggest a number of things, none of which are backed up by data. How well do we know that ATRA decreases thrombotic events? And why the rant about availability of diagnostics? This is a featured article, and as such it should not contain content that cannot be supported with reliable sources. I hope the editor is prepared to discuss the merit of these additions here first, rather than jumping ahead with further edits. JFW | T@lk 10:58, 26 September 2010 (UTC)

I changed the reference for the relative incidences from the reference

• Stevens, Alan; Lowe, J. F. (2000). Pathology. Edinburgh: Mosby. ISBN 978-0-7234-3200-5.

to one from medscape, because the former was taken from a table that was included in a lecture handout, and I traced it to the book by googling the text, which exactly matched text in that book - [2], but, since there appears to be no online access to that book, it seems like the medscape reference is more appropriate, at least until that book can be verified. Mikael Häggström (talk) 05:23, 26 August 2011 (UTC)

eg Quizartinib, good results in phase II for patients with FLT3-ITD. Not clear what % have that. - Rod57 (talk) 06:04, 18 December 2012 (UTC)

Hi. I'm med student currently undergoing Haematology.

Dc has given us a 2008 WHO classification, which includes up to 7 different types of AML. Haven't been able to correlate this with official sources, but if this is the case, it might be worth updating/referencing this 2008 classification instead of the old 2002 one?

First time I add content to wikipedia so sorry if I made anything wrong.

Daigixo (talk) 12:44, 19 May 2014 (UTC)

I have updated the WHO classification in the article to the current 2008 version. The article was still using the ancient 2002 WHO version :) Roman Bekker (talk) 16:22, 15 September 2014 (UTC)

The 2008 WHO subtypes are stated to be more clinically useful but the article does not explain how, or relate them clearly to the FAB types that the rest of the article still discusses. Since the article still documents the much older FAB system perhaps we should briefly describe the WHO 2002 classification (or how the 2008 system improves on it) ? - Rod57 (talk) 11:28, 19 May 2016 (UTC)

Good article in the New Yorker by Groopman on a new drug for treatment of IDH-2 AML presented at AACR and EHA.

The Transformation: Is it possible to control cancer without killing it?
By Jerome Groopman
September 15, 2014

OTOH this is Phase I research and Wikipedia likes to avoid every new overhyped "breakthrough" in the news. OTOH this is interesting science in its own right, and it's singled out by Groopman, who is a recognized expert, for an article in the New Yorker. He also gives elaborate explanations about why we should be cautious of even successful Phase I studies.

And Groopman has great background on AML written in language that is more understandable than Wikipedia can ever hope to be. For example, he describes what AML bone marrow looks like under the microscope. "Up close, healthy marrow looks like an Impressionist painting—a variegated landscape of cell types and colors. Leukemic marrow is a monotonous canvas of cancer cells."

Does anybody object to this going in? If so, why? --Nbauman (talk) 21:12, 14 September 2014 (UTC)

I object to most of that because at the moment the article does not even have a section on clinical research to cover phase III trials. We should cover phase III trials (in a new section on Clinical research) before we start on phase I. Unless this trial has revealed something new and notable about AML itself. IMO Groopmans description of the microscope images does not belong in WP - better would be to show the two images or link to them. ? - Rod57 (talk) 15:05, 18 May 2016 (UTC)

I am opposed to a section on clinical trials. It's not encyclopedic information - too transient. Jytdog (talk) 13:24, 19 May 2016 (UTC)

Does someone who knows something about cancer work out whether to add this new study: Mutant nucleophosmin and cooperating pathways drive leukemia initiation and progression in mice doi:10.1038/ng.796 (BBC News writeup). —Tom Morris (talk) 12:54, 28 March 2011 (UTC)

This article is definitely ripe for an update - the prognosis section should include more recent information on the use of FLT3 status, NPM1 (nucleophosmin), etc. since these are in clinical use as prognostic factors at present. I will take a look as time permits. MastCell ^Talk 16:55, 28 March 2011 (UTC)

Doesn't AML refer to all non-solid acute blood cell (precursor) malignancies? Or better, all acute leukemias excluding those of lymphoid lineage? Then would it not be a good idea to replace "The malignant cell in AML is the myeloblast." under Pathophysiology into "The malignant cells in AML can be precursors of all blood cells, except lymphocytes (which are classified as ALL)." And further in the text replace "myeloblast" with "blood cell precursor". The text as it is now would rather refer to Acute myeloblastic leukemia. Perencake (talk) 14:24, 25 July 2011 (UTC)

doi:10.1056/NEJMra1406184 JFW | T@lk 14:24, 17 September 2015 (UTC)

Diberri template filling tool doesn't seem to be working. Is that right? Is there a substitute? I've been doing it by hand. --Nbauman (talk) 01:53, 21 September 2015 (UTC)

Nbauman I use the "cite journal" template filler on the toolbar. It usually works and can fill templates from PMID and DOI identifiers. JFW | T@lk 12:42, 8 January 2016 (UTC)

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As can be seen in the Featured version, the citation style used in this article was the long-standing and well established Diberri format, with vancouver style authors and more than five authors truncated to three. Per WP:CITEVAR, I have restored the established citation style, so that one does not have to edit around 7,000 bytes of unnecessary citation template parameters. SandyGeorgia (Talk) 06:28, 6 September 2020 (UTC)