From the Guidelines
Patients with concurrent acute myeloid leukemia (AML) and rectal cancer require a highly individualized treatment approach, prioritizing the more immediately life-threatening condition, usually AML, with careful coordination between oncology teams, as suggested by the most recent guidelines 1. The treatment of AML typically involves induction chemotherapy regimens, such as "7+3" (7 days of cytarabine with 3 days of an anthracycline like daunorubicin), while rectal cancer treatment may include surgery, radiation, and chemotherapy, which must be carefully sequenced with AML therapy to minimize complications. Some key considerations in managing these patients include:
- The importance of achieving remission in AML while also considering the patient's ability to tolerate subsequent treatments, such as consolidation therapy or allogeneic stem cell transplantation 1.
- The need for careful sequencing of treatments for both AML and rectal cancer to minimize the risk of complications, such as severe myelosuppression, infections, and bleeding.
- The role of supportive care, including prophylactic antibiotics, transfusion support, and growth factors, in managing the increased risk of complications.
- The importance of individualizing treatment decisions based on factors such as patient age, performance status, and cytogenetic profiles of the AML, as well as the stage of both cancers. Treatment decisions should be made through a multidisciplinary tumor board involving hematologists, colorectal surgeons, radiation oncologists, and other specialists to develop an approach that balances treating both malignancies while minimizing complications, as emphasized in recent guidelines 1.
From the Research
Relationship Between Acute Myeloid Leukemia (AML) and Concurrent Rectal Cancer
- The relationship between AML and concurrent rectal cancer is complex and has been studied in various cases, with one study reporting a case of a 68-year-old male with AML who underwent robot-assisted Hartmann's procedure for rectal cancer 2.
- The study highlights the challenges of treating patients with concurrent AML and rectal cancer, as myelosuppression from AML can lead to prolonged sepsis and poor outcomes 2.
- Another study examined the use of concurrent chemoradiotherapy in the treatment of locally advanced rectal cancer, but did not specifically address the relationship between AML and rectal cancer 3.
- Studies have also investigated the treatment of AML, including the use of induction chemotherapy with intermediate-dosed cytarabine and subsequent allogeneic stem cell transplantation, which may be relevant to patients with concurrent AML and rectal cancer 4, 5.
- However, there is limited evidence on the specific relationship between AML and concurrent rectal cancer, and more research is needed to understand the optimal treatment approaches for these patients.
- A case report on the treatment of concurrent AML and untreated chronic lymphocytic leukemia (CLL) using venetoclax and rituximab may provide some insights into the treatment of concurrent hematological malignancies, but its relevance to rectal cancer is unclear 6.