b'New Therapeutic Combinations Show Promise in Acute Myeloid LeukemiaUnlike veterans with a variety of types of lymphoma, the expanded list of presumptive conditions for the PACT Act did not include acute myeloid leukemia or other types of leukemia. Because AML occurs primarily in older adults, with an average age at diagnosis of 68, it remains a challenge for clinicians treating veterans receiving care from the VHA.The good news, according to recent studies, is that novel combinations of treatment have now come online for older patients.By Annette M. BoyleCLEVELANDDespite the recent expansion of themanufacturing processes demonstrated that high serum presumptive cancers related to burn pit exposure, thelevels of TCDD correlated with higher risk for AML, VA has not included any types of leukemia, leavingleadingtheU.S. AgencyforToxicSubstancesand Gulf War and post-9/11 veterans with acute myeloidDisease Registry to conclude 15 years ago that [e]leukemia (AML) in the same position as their fel- pidemiological studies and case reports provide clear lows who served in Vietnam.evidence of a causal relationship between occupational Previousactiondeterminedthatalladultleuke- exposure to benzene and benzene-containing solvents mias,aplasticanemiaandothermyelodysplasticand the occurrence of acute myelogenous leukemia.syndromes,multiplemyelomaandnon-HodgkinStill, clinical studies documenting a link between lymphomas were presumptive conditions for veter- Agent Orange and AML have not been published. ans exposed to contaminated water at Marine CorpsOBrien attributed the lack of studies to both a vari-BaseCampLejeuneorMarineCorps AirStationability in the tracking of cases of AML and the long New River, NC.latency period between the Agent Orange exposure Thepresumptiveconditionsdeterminationsforand development of AML and so a lot of veterans exposure to Agent Orange and burn pits took a moremay have passed away from other causes before granular approach. For Vietnam veterans, a limitedAML develops or is diagnosed.number of blood cancers were individually evalu- Despite a lack of dioxin exposure assessments in ated and covered, including chronic b-cell leukemia,Vietnameraveterans,theVAacknowledgesthat Hodgkin disease, multiple myeloma and non-Hodg- Agent Orange was contaminated by TCDD or diox-kin lymphoma. For burn pits, all lymphomas wereins and benzenes, which are known carcinogens, included but no forms of leukemia. OBrien said. Yet veterans of Camp Lejeune who In a recent presentation sponsored by the Associationwere exposed to benzene contaminated water, who ofVAHematology/Oncology(AVAHO),Timothywent on to develop AML qualify for service-connec-OBrien,MD,sectionchiefofhematologyatthetion benefit.Louis Stokes Cleveland VAMC discussed findings from a number of studies that showed an associa- Elderly Veterans With AMLtion between benzene exposure and AML. BenzeneRegardless of the determination of a service connec-isametaboliteofthehighlycarcinogenicdioxintion, a significant number of veterans who receive 2,3,7,8-tetrachlorodibenzo-p-dioxin(TCDD),acare through the VA have AML. For them, accessing common contaminant of Agent Orange. TCDD anda treatment that keeps the disease at bay is their high-benzene have been shown to induce chromosomalest priority. abnormalities common in patients with AML.The National Cancer Institute estimates that more Further,datafromindustrialaccidentsandthan 73,000 people in the U.S. have AML and about 16'