Bailey

Breanna Bailey

ENG 1201

Professor Tyler

1 November 2020

Is Chemotherapy a Good Treatment for Acute Myeloid Leukemia?

My grandmother got diagnosed with leukemia in 2015. She instantly began treatments,

including chemotherapy. Some days, my grandmother felt completely normal. She took all her

grandkids on trips, hosted family gatherings and remained fairly active. Other days, the

chemotherapy made my grandmother feel so sick just sitting up in bed was nearly impossible. On

these days, my grandmother would be so drained and would not eat for long periods of time. By

the fourth round of chemotherapy, she was bedridden up to 6 days a week. My grandmother tried

many different treatments, from chemotherapy to self-prescribed homeopathic medicines. While

my grandmother was a big fan of the homeopathic medicines she was treating herself with, my

grandmother admits that even though the chemotherapy made her extremely ill at times, it is

without a doubt the best, and safest, treatment option that the doctors gave her. Other options the

doctors gave my grandmother were extremely risky surgeries, like bone marrow transplants.

Chemotherapy treatments are worth the risks associated with them because they have been

proven to increase the survival rate for leukemia patients and make leukemia untraceable in the

body.

So, what is Acute Myeloid Leukemia? Acute Myeloid Leukemia starts in the bone

marrow and [usually] moves very quickly into the blood. It may also move into other parts of the

body including the lymph nodes, liver, spleen, brain, spinal cords, and testicles. Acute Myeloid
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Leukemia often develops from cells that would normally turn into white blood cells. Acute

Myeloid Leukemia attacks and kills healthy cells in the body. Acute Myeloid Leukemia is

caused by changes in the DNA in normal bone marrow cells (“What Is (AML)”). A study was

conducted by doctors and researchers to understand the patients' experience with AML. The

doctors and researchers found that the most common symptoms of Acute Myeloid Leukemia are

bruising, weakness, fatigue, dizziness, shortness of breath, and bleeding (Tomaszewski et al.)

Chemotherapy is the most common and the most promising treatment for Acute Myeloid

Leukemia. Most of the side effects of AML and Chemotherapy are the same, like fatigue and

bruising, so patients are not experiencing any new symptoms.

So, what is chemotherapy? The American Cancer Society is an organization that raises

money for cancer research and treatments. The American Cancer Society explains that

chemotherapy is the use of anticancer drugs that get inserted through the patient's veins, under

the patient’s skin, through spinal fluids, or taken by mouth. No matter how the medicine is taken,

it will work its way through the bloodstream to reach the entire body (“Chemotherapy for

(AML)”). This procedure, along with other medications and a lot of rest, has been proven to

increase the survival rate of patients with Acute Myeloid Leukemia. However, some people

believe that chemotherapy is actually poisonous to the body and can make a person even sicker

and this belief stems from where chemotherapy came from.

Understanding where chemotherapy came from is important to understand why people

are either for it or against it. “Chemotherapy is the main treatment for most people with acute

myeloid leukemia (AML)” (“Chemotherapy for (AML)”). The use of chemotherapy started in

the early 20th century, around 1940. Ananya Mandal is a medical doctor from a government

medical college in West Bengal who teaches Pharmacology. In an article written by Mandal

about the history of chemotherapy, Mandal explains that “During World War II, it was
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discovered that people exposed to nitrogen mustard developed significantly reduced white blood

cell counts” (Mandal). In the 1940s, Alfred Gilman and Louis Goodman began to study the

effects of mustard agents while treating lymphoma. The Goodmans first created lymphomas in

mice to prove that the tumors could be treated with the mustard agents. The Goodmans then

began working with Gustav Linskog. Gustav Linskog was a thoracic surgeon. Together, Alfred,

Louis, and Gustav injected a patient who had nonHodgkin’s Lymphoma with a less dangerous

form of the mustard gas, which is called mustine. The Goodmans and Linskog found that using

mustard gas reduced the patient’s tumor masses for a couple of weeks after treatment, which was

very promising. Even though the patient had to return to receive more chemotherapy, the success

of this trial marked the beginning of the use of chemotherapy and cytotoxic agents for the

treatment of cancers (Mandal).

How is chemotherapy administered to patients now? Today, chemotherapy is given to a

patient by an infusion into a vein or taken as tablets/pills. Informed Health is a website whose

main goal is to inform people of the benefits and drawbacks of the different treatment options

and healthcare aids cancer patients can choose from. In Informed Health’s article on how

chemotherapy works, they explain that “...These medications travel in the bloodstream...so they

can also reach cancer cells that aren't detected in examinations, and that can therefore not be

targeted with surgery or radiation.” (“How does chemotherapy”). In certain cancers, it is also

possible to use local chemotherapy. Local chemotherapy is when the medicine is injected

directly into the affected area. Usually, chemotherapy is combined with radiotherapy

(chemoradiotherapy) because some cytostatics are only effective when the two treatments are

combined. Chemotherapy is the most common treatment for most types of cancers, including

leukemia.
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What happens if an Acute Myeloid Leukemia patient refuses chemotherapy? If a patient

with Acute Myeloid Leukemia refuses chemotherapy, there is really no other option for

treatment. A patient who refuses chemotherapy is usually an older patient who does not want to

deal with the side effects of chemo. However, after a certain amount of chemotherapy, a patient

does have the option to discontinue chemotherapy and have a bone marrow transplant. Bone

marrow transplants are painful and extensive surgeries that doctors do not usually recommend.

Who can get Acute Myeloid Leukemia? Cancer.Net is a website made up of doctors and

researchers from around the world to share information and statistics on different forms of

cancers. In Cancer.Net’s article on Acute Myeloid Leukemia, they state that: “This year, an

estimated 19,940 people of all ages (11,090 men and boys and 8,850 women and girls) in the

United States will be diagnosed with Acute Myeloid Leukemia (“Leukemia”). The number of

Acute Myeloid Leukemia cases increased by 2 percent between 2007 and 2016. AML is

diagnosable at any age but is uncommon in people under 45; the average age for diagnosis is 65.

There are an estimated 11,180 deaths from Acute Myeloid Leukemia this year, and most of the

deaths will be adults. The five-year survival rate is 25% for people 20 and older and 20% for

people younger than 20. The five-year survival rate is the percent of people who will live at least

five years after being diagnosed (“Leukemia”). The number of deaths could decrease

tremendously if more patients were allowing doctors to treat them with chemotherapy. While

chemotherapy may not save every life, chemo is the most likely to lead patients into remission.
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Statistics from the Leukemia & Lymphoma Society’s transcript show that in 2017, there are

(fig. 1)

about 21,000 new cases of Acute Myeloid Leukemia each year with about 11,000 deaths (see fig.

1) (David).

For a patient with Acute Myeloid Leukemia, chemotherapy tends to mean remission. Remission

means that a person does not have symptoms of the disease and their blood cell counts are in the

normal range. Rachel Nall is a certified registered nurse who has been a freelance medical writer

since 2004. In Nall’s article about the survival rates for patients with Acute Myeloid Leukemia,

she explains that about 2 out of 3, or 67 percent, of people with Acute Myeloid Leukemia will go

into remission after the first dose/round of chemotherapy (Nall). This may not seem like a long

time, however the first dose or round of chemotherapy takes at least a month in most cases. It is
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also important to note that how fast a patient achieves remission depends on how long the patient

waited to be treated; or how much the cancer has spread. Chemotherapy treatments have one of

the highest remission rates out of all other treatment options, and are actually one of the safest

options, despite popular belief. However, it is important to remember that chemotherapy is not a

miracle. My grandmother did not go into remission until five years after being diagnosed and she

was very good about following the doctor’s orders and taking care of her body.

A study was done on the different outcomes of chemotherapy treatments done on

different age groups. The study explained that “In a cooperative prospective study conducted in

Argentina (6), 390 children (younger than 16 yr) and 75 adults with ALL treated on similar

regimens had remission rates of 84 and 61%, respectively” (Pui). This means that the

chemotherapy actually helped these patients. The remission rates were over half of the total

number of patients, and there is still the chance that more of these patients went into remission

after the study concluded. It is easy to see the positive aspects of chemotherapy outweigh the

negative in a multitude of ways.

Since chemotherapy is a medical treatment, there are going to be side effects.

Cancervic.org is an organization created to educate cancer patients on their cancers, their

treatment options, and the side effects of their treatments. Cancervic.org’s article on the side

effects of chemotherapy explains that: “Side effects are caused when the chemotherapy damages

rapidly dividing healthy cells”(Chemotherapy). Chemotherapy can damage your healthy cells

accidentally while the medicine tries to kill all of the cancer-causing cells. This may weaken the

patient's immune system and cause them to get sick with common illnesses, like a cold, easier.

Chemotherapy, along with other treatments for AML, requires a lot of bed rest. Common side

effects of chemotherapy include fatigue, loss of appetite, nausea, bowel issues, hair loss, mouth

sores, and skin issues. Issues like trouble concentrating or remembering are also common with
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chemo. Chemo patients are also at a higher risk for infection because the chemotherapy can

reduce your white blood cells, which are used to fight infections. Usually, side effects are only

temporary and will gradually reduce/ improve after treatment. However, managing the side

effects is simple. A doctor will prescribe medicines that help keep the side effects under control

and give suggestions for what to eat and drink to help as well (Chemotherapy). If a patient is

good about following their doctor’s orders, they are just one step closer to remission. As stated

before, my grandmother followed the doctors orders for 5 years before she went into remission.

The key to chemotherapy is patience. However, there are still times when a patient refuses

chemotherapy because of the negative stigma behind the treatments and the medicines used.

Even with all of the positive results of chemotherapy, there are some people who are

unsure about it. Some people believe that chemotherapy is actually poison because of where

chemotherapy came from, as explained in paragraph two. Julie Wilkinson is a registered nurse

and a former writer for VeryWell Health. In Wilkinson’s article on why people are refusing

chemotherapy, she explains that “A moderate percentage of no-chemo proponents used the

chemo-is-mustard-gas rationale for refusal. Although this point is partially based in fact, science

has come leaps and bounds since those first experiments using mustard gas, or mustard

nitrogen…” (Wilkinson). However, this belief is outdated. The rumor that chemotherapy is

poison came about when people were learning that the doctors who created the chemotherapy

treatments discovered them through people being exposed to nitrogen gas, which is toxic. There

has been decades of research and advancements in chemotherapy treatments and doctors have

insured that they are as safe as possible, which working to make them easier to endure.

Another reason patients refuse chemo is because they are worried about what it will do

to their natural defenses. People believe that chemotherapy treatments kill the immune system.

While there is some truth in this claim, Wilkinson explains that “Chemotherapy does not kill
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your immune system as claimed, but it can harm it temporarily” (Wilkinson). This means that

going through chemotherapy treatments may make allow you to get sick easier and cause issues

like fatigue.However, doctors will properly prepare a patient for this, since it will be easier to get

sick. The doctor will give a list of restrictions to follow and what to do to keep yourself safe and

healthy. Finally, people may refuse chemotherapy because they believe that it is a carcinogen.

The reality is that the medicine used in chemotherapy treatments can be harmful to completely

healthy people that come into contact with it, as with any medicine that is taken by a person who

does not need it. For a patient with an illness that requires chemotherapy, the medicines will not

cause any other long-term illnesses, only the side effects (Wilkinson) .

What about the other treatment options out there? Maggie Fox is a senior editor for CNN

news who has been reporting and editing medical news for twenty years. In Fox’s article on

whether or not chemotherapy is obsolete, she explains that: “Cancer therapy is being transformed

as immune therapies, targeted treatments based on DNA profiles and personalized treatments

make stunning advances in some patients” (Fox). The keywords in Fox’s article is “some

patients”. There has not been enough research done to determine if the personalized treatments

are safe. These treatments are administered to high paying people who can afford to fix almost

anything that goes wrong during the treatment process. A regular middle- or lower-class citizen

honestly should not consider the personalized treatments unless the doctor suggests it and/or the

traditional treatments, like chemotherapy and bone marrow transplants, do not work. Even with

the new personalized treatments for patients of certain cancers, chemotherapy is still the best

option. The side effects of the new treatments can be extremely worse than those of chemo, and

since the treatments are fairly new there is really no telling what can happen. While there is a

slight chance that a patient could have a different reaction to chemo than what is common,

doctors would know what to do since it has been around for decades.
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Will other treatments replace chemotherapy in the future? The National Library of

Medicine is a center for biotechnology medicine. In their article “Will Targeted Therapies

Replace Chemotherapy?”, The National Library of Medicine explained that “The Oncologist

Dream is to provide more benefit with lower toxicity” (Collignon). Oncologists are working to

on coming up with alternatives to chemotherapy so that in the future we will have a painless

treatment option with little to no side effects. However, developing safe medicines takes a lot of

time. Remember that being a test subject for these developmental treatments are risky. While

doctors are slowly developing targeted treatments for all cancers, including Acute Myeloid

Leukemia, chemotherapy is still the best option for treatment we have today.

Even with all of the advancements in Acute Myeloid Leukemia treatment, chemotherapy

remains the best option. Chemotherapy has been around for many years and there has been

enough research done for doctors to know how to handle almost any situation. Doctors have had

time to gain experience in almost any situation that may arise during chemotherapy. Doctors are

able to make personalized plans for patients to help make recovery go as smoothly as possible.

Remission rates from chemotherapy are some of the highest out of any other treatment options.

Yes, chemotherapy may make you feel sicker but the results at the end of treatment are worth it.

While there are new, more personalized treatment options that may seem like a better option,

there has not been enough research done or enough long-term usage to say that these treatments

are better or safer than chemo. There are oncologists out there working on improving and

creating new treatments for all cancers, including Acute Myeloid Leukemia. Of course, these

may become the preferred treatment option in years to come, but for now chemotherapy

treatments are the best treatment option for patients with Acute Myeloid Leukemia, even when

considering the risks associated.

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Works Cited

“Chemotherapy for Acute Myeloid Leukemia (AML).” American Cancer Society, 2020,

www.cancer.org/cancer/acute-myeloid-leukemia/treating/chemotherapy.html.

“Chemotherapy.” Side Effects of Chemotherapy | Cancer Council Victoria, 2020,

www.cancervic.org.au/cancer-information/treatments/treatments-

types/chemotherapy/side_effects_of_chemotherapy.html.

Collignon J, Jerusalem G. Les traitements ciblés remplaceront-ils la chimiothérapie? [Will

targeted therapies replace chemotherapy?]. Rev Med Liege. 2012;67 Spec No:29-36.

French. PMID: 22690483.

David , Steensma P. “What's On The Horizon for Acute Myeloid Leukemia .” Leukemia &

Lymphoma Society , 2 Nov. 2017,

www.lls.org/sites/default/files/National/USA/Pdf/Slides_Transcipts/transcript_aml_11.2.

17.pdf.

Fox, Maggie. “Is Chemo Obsolete? Not by a Long Shot, Cancer Experts Say.” NBCNews.com,

NBCUniversal News Group, 25 June 2018, www.nbcnews.com/health/health-

news/chemo-obsolete-not-long-shot-cancer-experts-say-n885811.
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“How Does Chemotherapy Work?” InformedHealth.org [Internet]., U.S. National Library of

Medicine, 15 Aug. 2019, www.ncbi.nlm.nih.gov/books/NBK279427/.

“Leukemia - Acute Myeloid - AML - Statistics.” Cancer.Net, 19 Feb. 2020,

www.cancer.net/cancer-types/leukemia-acute-myeloid-aml/statistics.

Mandal, Dr. Ananya. “History of Chemotherapy.” News, 26 Feb. 2019, www.news-

medical.net/health/History-of-Chemotherapy.aspx.

Nall, Rachel. “Acute Myeloid Leukemia: Survival Rates and Outlook.” Healthline, Healthline

Media, 3 Feb. 2020, www.healthline.com/health/acute-myeloid-leukemia-survival-rates-

outlook.

Pui, Ching-Hon. Treatment of Acute Leukemias : New Directions for Clinical Research. Humana

Press, 2003. EBSCOhost, search.ebscohost.com/login.aspx?

direct=true&db=nlebk&AN=82956&site=eds-live.

Tomaszewski, Erin L., et al. “Understanding the Patient's Experience with Acute Myeloid

Leukemia: A Patient Interview Study.” Blood, American Society of Hematology, 3 Dec.

2015, ashpublications.org/blood/article/126/23/2121/105073/Understanding-the-Patient-

s-Experience-with-Acute.

“What Is Acute Myeloid Leukemia (AML)?: What Is AML?” American Cancer Society, 2020,

www.cancer.org/cancer/acute-myeloid-leukemia/about/what-is-aml.html.

Wilkinson, Julie. “Understand Why More People Are Refusing Chemotherapy.” Verywell

Health, 23 Sept. 2020, www.verywellhealth.com/should-you-do-chemo-796883.

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