Is there a cure for acute myeloid leukemia?

Is there a cure for AML? So, AML is not one disease. AML is many diseases, and I think we will talk about that. There are cures for AML. I mentioned already acute pro-myelocytic leukemia. So, that's a fantastic story. My very first patient had acute pro-myelocytic leukemia. And when I came back the next day to think about treatment, he had already died. And that was very common because these patients have a blood clotting disorder and they can bleed to death overnight. So, obviously, I never forgot that. And in the old days, these patients were treated with chemotherapy. The mortality was 30% in the first few weeks, and the cure rate was about 30%. Today, we have zero mortality and the cure rate, and I don't mean remission, but cure rates of 80 to 90%. So, how did that happen? It's a very interesting story. A Chinese investigator was working at the NCI and returned to China. He had worked on what's called Atra, which is a vitamin. And at that time, they couldn't support leukemia patients under chemotherapy with blood products and antibiotics and so on. So, he tried out this Atra treatment in patients in China, and he had a spectacularly high response rate. So, nobody would expect any responses. I think based on his prior work at the NCI, he thought this might work and it did work. So the response rates were very, very high, but then most patients relapsed. So this happened first in Harbin in China. And in the same university, they then used arsenic trioxide as a second drug. And the combination of all trans-vitinoic acid, Atra, and arsenic resulted in these cure rates. And sometimes we are adding other drugs, but these cure rates now are universal. And the clotting disorder, which has killed my patient and many patients very early on, is resolved after a few days. So this is really a miracle example how good research can be translated. So this is not the only leukemia we can cure. We have cure rates of about 60% in certain leukemias that are defined by certain molecular abnormalities and chromosomal abnormalities. Then we have leukemias that we cannot cure. The worst leukemia is the one with a P53 mutation. So that is still the highest hanging fruit. And we are working on this very actively in many other groups, of course. But we haven't made much progress for these leukemias. Then there are many other groups defined by mutations, which we will discuss in a minute. For instance, Flick III mutations, which have had very bad prognosis, and now they can be cured with a combination of targeted therapies and bone marrow transplantation. So yes, so the answer is we are curing an ever-increasing number of patients. We have very specific treatments now that we know works in some patients and does not work in others. So it's very important to pick the best combination therapy for individual patients. And by doing this, we have year after year after year increased the cure rates of acute myeloid leukemias. There is a cure for some patients with AML. Previously, we were like a one-trick pony. We had standard combination aggressive chemotherapy and take it or leave it. It worked sometimes. It didn't work other times. And you may or may not benefit from an allogeneic stem cell transplant. Currently, with our evolving understanding of the disease and what drives the disease in the specific patient, we've been able to develop many more therapies that can be applied to patients with specific findings in their AML. So we have the ability now to target a patient's AML much more so than we used to. So chemotherapy often is still part of the primary plan, but less and less so. And the newer therapies are focused on optimizing response while we minimize toxicity and damage to the patient. And often that's because we can better target the specific patient's leukemia rather than general chemotherapy that will poison the whole body.