Overview
Acute myeloid leukaemia (AML) is a kind of blood cancer that begins in the bone marrow, the soft inner part of bones. AML usually starts in cells that turn into white blood cells, but it can start in other blood-forming cells, as well. The bone marrow generates three kinds of cell lines, namely:
- White blood cells
- Red blood cells
- Platelets
White blood cells help in the prevention of infections in the body. In people with AML, the bone marrow generates abnormal white blood cells. These cancer cells are termed myeloblasts which quickly transfers from the bone marrow into the circulatory system and can even involve other parts of the body, like lymph nodes, liver, spleen, brain, spinal cord and testicles. Various other names for acute myeloid leukaemia are as follows:
- Acute myelocytic leukaemia
- Acute myelogenous leukaemia
- Acute granulocytic leukaemia
- Acute non-lymphocytic leukaemia
AML is a life-threatening condition and If left untreated, life span is in weeks to months.
Acute Myeloid Leukemia Symptoms
Acute myeloid leukaemia presents with Patients might have:
- Fever
- Bleeding manifestations including bruising or gum bleed, bleeding from nose, blood in urine or stool
- Anemia or low Hb
- Fatigue
- Weight loss or loss of appetite
- Tiny red spots on the skin (petechiae)
- Swollen gums
- Enlarged liver or spleen
- infections
- Shortness of breath
- Pain in the bones
Acute Myeloid Leukemia Causes
Acute myelogenous leukaemia develops when a bone marrow cell develops a certain type of mutation in its genetic material, DNA which contains the instructions regarding cell growth at a particular rate and cell death as well. However, in acute myelogenous leukaemia, these mutations tell the bone marrow cell to keep growing and dividing as well.
When these events take place, cell production goes out of control. The bone marrow generates immature cells that turn into leukemic white blood cells called myeloblasts which are unable to function properly, multiply and replace healthy cells.
Diagnosis of Acute Myeloid Leukemia
If the person presents with signs or symptoms of acute myelogenous leukaemia, the doctor may recommend certain diagnostic tests like:
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Blood tests.
Most people with acute myelogenous leukaemia possess excessive amounts of white blood cells in comparison to red blood cells and platelets. The presence of myeloblast cells is yet another indication of acute myeloid leukaemia.
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Bone marrow test.
During the bone marrow biopsy procedure, a needle is inserted to obtain a sample of bone marrow. Usually, the sample is taken from the hipbone and sent to a laboratory for detailed examination.
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Lumbar puncture (spinal tap).
In certain conditions, it may be necessary to extract some amount of the fluid by inserting a small needle into the spinal canal from the spinal cord region to look for leukaemia cells.
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Testing of cancer cells in the laboratory set-up.
In a laboratory, doctors test the leukaemia cells to better understand which kind of gene mutations are involved. It helps to determine the prognosis and form the treatment plan.
Acute Myeloid Leukemia Treatment
Acute myeloid leukaemia (AML) is responsible for the formation of a large number of abnormal as well as underdeveloped blood cells, which are known as blast cells which in turn replace healthy and normal RBC's, white blood cells, and platelets. The main aim of AML treatments is to destroy unhealthy immature blood cells in the bone marrow and bloodstream. The focus is to put the patient into a complete remission phase, which implies the patient doesn't have any blood markers or any evident signs and symptoms of cancer.
Several different treatments are given for AML, which are:
- Chemotherapy
- Bone marrow Transplant or Stem cell transplant
- Targeted therapy
The treatment is divided into two phases:
Phase 1: Remission induction therapy
The patient who is young and fit to receive intensive treatment receives high doses of chemotherapy in order to destroy the leukaemia blast cells. There are basically chemotherapy medicines.
After the completion of four to six weeks of treatment, the bone marrow should start making fresh and healthy blood cells. The doctor will take a bone marrow sample and perform certain tests to look for any leukaemia cells left in the blood. If no signs of leukaemia cells are detected, doctors call that being "in remission." Patients still need to go through post-remission therapy to help them stay in remission.
Phase 2: Post-remission therapy (Consolidation):
Post-remission therapy uses more treatments to wipe out any cancer cells that might have been left behind after chemotherapy. This is called a complete remission. The patient has three options:
- Chemotherapy. A patient may get several cycles of high-dose chemotherapy once a month.
- Allogeneic (from a donor) stem cell transplant. This often depends on baseline risk category as decided by genetic/molecular tests.
- Autologous (self) stem cell transplant
Risk Factors of Acute Myeloid Leukemia
Several factors that possibly increase the risk of developing acute myelogenous leukaemia (AML) comprises:
- Increasing age: The risk of AML increases with age and is commonly seen in adults with age 65 years and above.
- Sex: Men are more prone to exhibit this condition than women.
- Previous cancer treatment: People who have already gone through certain types of chemotherapy and radiation therapy are at a greater risk of having AML in future.
- Exposure to radiation: People who are frequently exposed to very high levels of radiation are again at a higher risk of having AML.
- Dangerous chemical exposure: On exposure to certain chemicals like benzene, patients are linked to a greater risk of developing AML slowly.
- Smoking.
- Other blood disorders: People with certain blood disorders like myelodysplasia, myelofibrosis, polycythemia vera or thrombocythemia are at higher risk of possessing AML.
- Genetic disorders. Certain genetic disorders like Down syndrome are associated with a potentially higher risk of AML.
Complications of Acute Myeloid Leukemia
These include:
- Infections
- Weakened immune system
- Bleeding
- Infertility
Outlook of Acute Myeloid Leukemia
The majority of the adults with AML go into remission after getting chemotherapy. There are no visible or detectable cancer cells present in the bone marrow, and the normal healthy cells are growing again and replacing them.
Since there is a possibility that AML often has a tendency to bounce back (relapse) again, it is advised to continue the chemotherapy sessions to destroy any residual cancer cells if present. Doctors term this step as post-remission (consolidation) chemotherapy. Around half of the people who receive this treatment progress towards long-term remission.
If cancer recurs a bone marrow stem cell transplant is recommended if patients are in a healthy state to tolerate it.