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Acute Myeloid Leukemia (AML) 

 

Acute myelogenous leukemia or acute myeloid leukemia, or rarely acute nonlymphocytic leukemia (ANLL), is a cancer affecting a group of cells in the bone marrow or spinal cord called myeloid leukocytes. The tumor is characterized by an invasion of immature cells in the inner core of the organ affected (bone marrow or spinal cord) due to a blockage of maturation (hyatus leucemicus) of white blood cells in the bone marrow that will be responsible for bone marrow failure by crushing the normal lines which tends to cause anemia, bleeding, susceptibility to infection; and tumor syndrome such as pain at the epiphyses (the rounded end of a long bone).  

 

Signs and Symptoms  

 

Although some cases are asymptomatic, Signs and Symptoms of acute myeloid leukemia are quite common and can be combined with various common diseases which can make the diagnosis a little bit challenging at the beginning. In general, if you have the disease, these symptoms maybe experienced:  

  • Anemia 
  • Joint pain 
  • Fatigue 
  • Paleness of the face (pallor) 
  • Respiratory problems 
  • Loss of appetite and / or weight loss;  
  • Fever associated with night sweating; 
  • Frequent and persistent infections; 
  • Petechiae: small flat and round red or purple spot under the skin surface which can cause rashg ( petechialrash)  

Causes 

 

Acute myeloid leukemia is not attributed to a single cause or factor, but a number of risk factors. Common causes associated with developing AML that have been identified include: genetics, blood disorders (myelodysplastic syndrome or myeloproliferative disease), certain chemical exposures (chemotherapy that contains alkylating agents, epipodophyllotoxins or/and anthracyclines), ionizing radiation or prolonged exposure to high levels of X-rays without formal protection, and others. 

 

Classifications  

 

Acute myeloid leukemia is divided in eight subtypes by the French-American-British (FAB) classification. These subtypes group from M0 to M7, based on the type of cell from which the leukemia developed and its degree of maturity.  

 

Type 

Name 

Percentage (adults) 

M0 

minimally differentiated acute myeloblastic leukemia 

 

5% 

M1 

acute myeloblastic leukemia, without maturation 

 

15% 

M2 

acute myeloblastic leukemia, with granulocytic maturation 

 

25% 

M3 

promyelocytic, or acute promyelocytic leukemia (APL) 

 

10% 

M4 

acute myelomonocytic leukemia 

 

20% 

M4eo 

myelomonocytic together with bone marrow eosinophilia 

 

5% 

M5 

acute monoblastic leukemia (M5a) or acute monocytic leukemia (M5b) 

 

10% 

M6 

acute erythroid leukemias, including erythroleukemia (M6a) and very rare pure erythroid leukemia (M6b) 

 

5% 

M7 

acute megakaryoblastic leukemia 

5% 

 

Treatment

The basic treatment for Acute myeloid leukemia is induction chemotherapy, called "7+3" (or "3+7") . The first course of chemotherapy (induction) often consists of cytarabine (ara-C) and an anthracycline (most often daunorubicin). The goal of the health care provider is to induce a complete remission clinically and haematologically. The induction chemotherapy tends to cause an absence of all or part of bone marrow normal function or production for 3 to 4 weeks, during which the patient must receive close supervision in a specialized hematology department to prevent bleeding and fetal infection risks.  

Further treatment depends largely on the type and prognostic factors for AML, but also the age of the patient and response to the induction chemotherapy. It consists of several courses of chemotherapy called postremission or consolidation therapy , which aim to eradicate residual leukemic cells. Consolidation therapy is very important to achieve a cure or prevent relapse which is very common without postremission. Allogeneic hematopoietic stem cells may also contribute to the curability of the disease. 

Induction chemotherapy is barely recommended to certain groups of patients such as the very elderly or patients with a very weak immune system. Other options may include less intense chemotherapy or palliative care.