Ask Dr. H: A blood cancer that can kill quickly

Posted: December 26, 2011

Question: Can you explain acute myelogenous leukemia? Someone we know was recently diagnosed with it, and two weeks later he was dead. What makes it so deadly?

Answer: Acute myelogenous leukemia, or AML, is a cancer of the blood in which immature, abnormal white blood cells grow rapidly and uncontrollably in the bone marrow and interfere with its ability to produce red blood cells, healthy white blood cells, and platelets. It's a fairly rare cancer, with men affected more often than women.

The average age of those diagnosed with AML is 63. AML cell growth is very fast and aggressive, and it is a fatal disease within weeks or months if not diagnosed and treated promptly.

Because AML cell growth crowds out normal blood cells, the disease typically causes anemia and the associated symptoms of fatigue and shortness of breath from a reduction in oxygen-carrying red blood cells; bruising or bleeding from a reduction in platelets (clot cells); and infection from a reduction in normal white blood cells.

The key to survival in AML is early diagnosis, chemotherapy to try to induce remission, and eventual stem-cell transplantation. There are several subtypes of AML, and treatment and prognosis vary among the subtypes. Five-year survival rates vary from 15 percent to 70 percent, and relapse rates vary from 33 percent to 78 percent.

To learn more about AML, check out this link from the American Cancer Society: www.cancer.org/cancer/leukemia-acutemyeloidaml/index.

Attention-deficit drugs and heart-attack risks

Q: After years of having problems with attention and focus, I am starting on Adderall XR for ADD (attention deficit disorder). I'm 43 years old and am wondering if I should be concerned about long-term use of a stimulant and the risk of it causing a heart attack in the future. I do have high cholesterol. What's your opinion?

A: That's been a theoretical concern for several years, prompting the Food and Drug Administration to put a "black box" warning on the package label describing the cardiovascular risks of stimulant drugs used to treat ADD and ADHD (attention deficit hyperactivity disorder) in adults. Their concern is that, theoretically, such stimulants could cause constriction of blood vessels in the heart and elsewhere, leading to a potential heart attack in persons at risk and a potential stroke in someone with uncontrolled blood pressure.

The good news is that the results of a large study just published on the Journal of the American Medical Association's website are reassuring in that there does not appear to be any statistically significant increase in heart attacks or strokes in folks who are prescribed amphetamine stimulants to treat ADD/ADHD. Researchers at four large health insurers looked at the medical and pharmacy records of 443,198 folks between 25 and 64, roughly one-third of whom had filled prescriptions for ADD/ADHD medications. The most commonly prescribed drugs were Ritalin and Adderall.

The analysis did not show any evidence that these medications increased the risk of heart attack, sudden cardiac death, or stroke. A similar study recently published in the New England Journal of Medicine found no increased risk of cardiovascular events in children and young adults.

While recent findings may prompt the FDA to review the current black box warnings on stimulants, I'd be sure to properly address an underlying high cholesterol or high blood pressure condition. Also, I'd avoid using stimulant drugs in someone who has known cardiovascular disease or uncontrolled high blood pressure.


Mitchell Hecht specializes in internal medicine. Send questions to him at: "Ask Dr. H.," Box 767787, Atlanta, Ga. 30076. Because of the large volume of mail received, personal replies are not possible.

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