General Information About Acute Myeloid Leukemia

Acute Myeloid Leukemia (AML) is a form of cancer originating in the bone marrow, characterized by the rapid production of abnormal blood cells. It primarily affects adults and is the most common type of acute leukemia in this age group. AML is known by various names, including acute myelogenous leukemia and acute nonlymphocytic leukemia.

AML can impact different blood cell types, including red blood cells, white blood cells, and platelets. Normally, the bone marrow generates blood stem cells that mature into various types of blood cells. A blood stem cell may develop into a myeloid stem cell, which, in turn, gives rise to three primary types of mature blood cells:

1. Red Blood Cells: Responsible for transporting oxygen and essential nutrients to the body's tissues.

2. Granulocytes: A type of white blood cell that plays a crucial role in combating infections and diseases.

3. Platelets: Blood components responsible for forming clots to stop bleeding.

 

In AML, myeloid stem cells often develop into immature white blood cells known as myeloblasts. These myeloblasts are abnormal and do not mature into healthy white blood cells. Sometimes, AML may result in an overproduction of abnormal red blood cells or platelets, leading to a reduced number of healthy blood cells. As a consequence, patients may experience symptoms such as infection, anemia, and a tendency to bleed easily.

Leukemia cells can infiltrate various parts of the body, including the central nervous system, skin, gums, and may occasionally form solid tumors called myeloid sarcomas. It's important to note that the information here primarily pertains to adult AML.

 

 

Subtypes of AML:

AML can be further categorized into different subtypes based on the degree of maturity of the cancer cells at diagnosis and how they differ from normal cells. One notable subtype is Acute Promyelocytic Leukemia (APL), characterized by specific genetic changes that hinder the maturation of certain white blood cells. APL is often associated with a high risk of bleeding and blood clotting issues.

 

 

Risk Factors for AML:

 Several factors may increase an individual's risk of developing AML, including:

• Being male.

• Older age.

• Smoking.

• Previous exposure to chemotherapy or radiation therapy.

• Exposure to environmental factors like nuclear radiation or the chemical benzene.

• A personal history of blood disorders like myelodysplastic syndrome.

• Certain genetic syndromes or inherited disorders.

 

 

Symptoms of AML:

The initial signs and symptoms of AML can mimic those of common illnesses like the flu. Common symptoms include:

• Weakness.

• Fever.

• Infection.

• Paleness or loss of normal skin color.

• Easy bleeding or bruising.

In some cases, clusters of leukemia cells in the central nervous system or testicles or the presence of myeloid cell tumors (chloromas) can cause less common symptoms.

 

 

Diagnosis of AML:

To diagnose AML, healthcare professionals typically perform several tests and procedures, including:

• Physical examination and health history.

• Complete blood count (CBC) to assess the number of blood cells.

• Peripheral blood smear to examine blood cells' appearance.

• Flow cytometry to evaluate cell characteristics.

• Bone marrow aspiration and biopsy to examine the marrow, blood, and bone for cancer cells.

• Tumor biopsy if myeloid cell tumors are present.

• Cytogenetic analysis to assess chromosome changes.

• Molecular testing to check for specific genes or genetic changes.

• Immunophenotyping to identify cancer cells based on surface markers.

• Reverse transcription-polymerase chain reaction test (RT-PCR) to measure genetic substances.

 

 

Prognosis and Treatment of AML:

Prognosis (chance of recovery) and treatment options depend on several factors:

• Patient's age.

• Whether leukemia has spread to the central nervous system.

• Presence of systemic infections.

• White blood cell count at diagnosis.

• AML subtype.

• Previous chemotherapy or radiation therapy.

• History of blood disorders.

• Whether the cancer has been treated before or recurred.

 

 

Treatment for AML typically involves two phases:

1. Remission Induction Therapy: The initial phase aims to eliminate leukemia cells from the blood and bone marrow, achieving remission.

2. Postremission Therapy: This phase follows remission and focuses on eradicating any residual leukemia cells that could lead to a relapse.

 

 

Treatment options for AML include:

• Chemotherapy: Using drugs to halt cancer cell growth or kill them. The choice of drugs and administration depends on the subtype of AML.

• Radiation Therapy: Employing high-energy radiation to destroy cancer cells or hinder their growth.

• Chemotherapy with Stem Cell Transplant: Replacing blood-forming cells after chemotherapy to regenerate the blood.

• Targeted Therapy: Using drugs or substances to target specific cancer cells or proteins involved in cancer growth.

• Other Drug Therapy: Utilizing medications like arsenic trioxide and all-trans retinoic acid for treating specific AML subtypes.

Clinical trials also explore novel treatments for AML. Patients may consider participating in clinical trials to access cutting-edge therapies.

Following treatment, patients often require follow-up tests to monitor their condition and check for any recurrence or changes. The management of untreated, remission, refractory, or recurrent AML varies based on the subtype and other individual factors.

 

 

Stages of AML:

AML does not have a standardized staging system like many other cancers. Instead, clinicians use the subtype of AML and whether leukemia has spread outside the blood and bone marrow to guide treatment decisions. Tests such as lumbar puncture and imaging like CT scans help assess the extent of the disease.

 

 

Conclusion:

Acute Myeloid Leukemia is a complex and potentially life-threatening disease that requires a personalized approach to diagnosis and treatment. Early detection, appropriate classification, and tailored therapy are essential in managing AML and improving patient outcomes. Clinical trials continue to advance our understanding and treatment options for this challenging condition.

 

 

References

• Leukemia Research Foundation. Acute Myeloid Leukemia. (https://leukemiarf.org/leukemia/acute-myeloid-leukemia/) Multiple pages viewed. Accessed 3/21/2023.

• National Organization for Rare Disorders. Acute Myeloid Leukemia. (https://rarediseases.org/rare-diseases/acute-myeloid-leukemia/) Accessed 3/21/2023.

• The Aplastic Anemia and MDS International Foundation. Acute Myeloid Leukemia (AML). (https://www.aamds.org/diseases/acute-myeloid-leukemia-aml) Accessed 3/21/2023.

 

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