• Secondary malignancy (therapy-related cancer): A new, different cancer caused by the treatment of the first one: leukaemia after alkylating chemotherapy or PARP inhibitors, solid tumours in irradiated tissue decades later, and rarely T-cell lymphoma after CAR-T.
• Anaemia: A shortage of red blood cells or haemoglobin, causing tiredness and breathlessness.
• Differentiation syndrome: When a targeted drug makes leukaemia cells mature all at once, causing fever, fluid in the lungs, and weight gain.
• Immunomodulatory drugs (IMiDs) and CELMoDs: Thalidomide and its descendants lenalidomide and pomalidomide, which hijack a cellular waste-disposal tag (cereblon) to destroy two proteins myeloma cells depend on, while also revving up T and NK cells.
• Epigenetic progenitor theory: cancer without a first mutation: The proposal that cancer begins not with a mutation but with a reversible change in how genes are switched on and off in a stem or progenitor cell, which then makes later mutations more likely and more dangerous.
• Ageing tissue and clonal fields: cancer as a disease of old tissue: Sequencing of healthy skin, gullet and blood shows that by middle age they are patchworks of mutant clones, many carrying classic cancer mutations, yet cancer stays rare until old age.
• ELN 2022 risk classification: The three-tier system (favourable, intermediate, adverse) that decides how aggressively an adult with AML is treated and whether a transplant is recommended.
• Hypomethylating agents (azacitidine, decitabine): Low-intensity chemotherapy that strips chemical 'off' switches (methyl groups) from DNA so silenced genes can be read again.
• Cytopenias and myelosuppression: The umbrella term for low blood counts of any kind (white cells, red cells, platelets) when treatment suppresses the bone marrow.
• Blasts (leukaemic blast cells): Immature blood cells that should mature in the marrow but in acute leukaemia multiply without growing up.

Biomarker results to ask for: IPSS-R and IPSS-M risk, Cytogenetics (del(5q), -7, complex karyotype), NGS panel (SF3B1, TP53, ASXL1, RUNX1, TET2, DNMT3A, SRSF2, U2AF1), Blast percentage, Serum EPO level (ESA response prediction), Transfusion burden.

Scans and tests linked to this cancer: Cytogenetics and FISH, Multiparameter flow cytometry MRD, NGS-based MRD (clonoSEQ and molecular MRD), Ex vivo drug sensitivity screening in blood cancers (EXALT).

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

• Lower risk, anaemia: ESA if serum EPO <500; luspatercept first line (COMMANDS) or after ESA failure (MEDALIST); imetelstat after ESA failure (IMerge); lenalidomide for del(5q). (Luspatercept, Imetelstat, Lenalidomide)
• Higher risk, transplant candidate: Allogeneic HSCT, usually after hypomethylating-agent cytoreduction; BMT CTN 1102 showed a survival benefit for transplant in 50-75-year-olds. (Allogeneic stem cell transplantation, Azacitidine)
• Higher risk, not transplant candidate: Azacitidine (AZA-001) or decitabine / oral decitabine-cedazuridine until progression; supportive care and trials. (Azacitidine, Decitabine + cedazuridine (oral))
• Supportive care, all risks: Transfusion, iron chelation for transfusional iron overload (TELESTO), infection management, G-CSF for neutropenic infection. (Transfusion support and anaemia management, Growth factors: G-CSF and febrile neutropenia prevention)

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.