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Acute myelogenous leukemia (AML)

Definition


Disease: Acute myelogenous leukemia (AML) Acute myelogenous leukemia (AML)
Category: Blood diseases & tumors
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Disease Definition:

Also known as acute myeloblastic leukemia, acute nonlymphocytic leukemia, acute myeloblastic leukemia and acute myeloid leukemia, AML (acute myelogenous leukemia) is a type of cancer of the blood and bone marrow, which is the spongy tissue inside bones where blood cells are made. In acute myelogenous leukemia, the word "acute" refers to the fact that the disease affects immature blood cells and progresses rapidly. Myelogenous refers to the white blood cells, which are called myeloid cells that AML affects.
The myeloid cells develop into the various types of mature blood cells, such as white blood cells, red blood cells and platelets.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Many signs and symptoms of the early stages of AML can resemble those of the flu or other common diseases. These signs may also vary according to the type of the blood cell affected. AML signs and symptoms may include:

  • Bone pain
  • Pale skin
  • Easy bruising
  • Shortness of breath
  • Fever
  • Lethargy and fatigue
  • Frequent infections
  • Weight loss
  • Bleeding from the gums, frequent nosebleeds and other unusual bleeding.

AML worsens quickly if not treated, so a prompt diagnosis is helpful. In case unusually or worrisome signs and symptoms are noticed, a doctor should be consulted.

Causes:

AML occurs when the DNA of developing cells in the bone marrow is damaged, causing blood cell production to become uneven.
 
Immature cells are produced by the bone marrow, which develop into myeloblasts, the leukemic white blood cells. These abnormal cells are unable to function properly, so they build up and crowd out healthy cells.

Although the cause of DNA mutations that lead to leukemia are not clear, radiation, exposure to certain chemicals and some chemotherapy drugs may play a role. It is also believed that most cases of acute myelogenous leukemia aren't inherited.

Complications

Complications:

None

Treatments:

AML treatment depends on several factors, such as the patient’s age, overall health, preferences and the subtype of the disease. The treatment of this disease has two phases:

THE 1ST PHASE: INDUCTION THERAPY
In this phase the leukemia cells in the blood and bone marrow are killed, but to prevent the disease from returning, further treatment is needed because remission induction usually doesn't wipe out all of the leukemia cells.

THE 2ND PHASE: CONSOLIDATION THERAPY
In this phase the remaining leukemia cells are destroyed. Also called post-remission therapy, maintenance therapy or intensification, consolidation therapy is considered crucial to decreasing the risk of relapse.

Some of the therapy methods that are used in these phases are:

Biological therapy:
This method, also known as immunotherapy, uses substances that bolster the immune system's response to cancer.
One form of biological therapy is known as monoclonal antibodies. Although these antibodies are produced in a laboratory, they mimic proteins in the immune system (antibodies) that attack foreign substances on leukemic cells. Gemtuzumab ozogamicin  is one monoclonal antibody that is used as a biological therapy in AML. When this drug attaches to AML cells, it releases a chemical toxin that it carries.

Chemotherapy:
Though it can also be used for consolidation therapy, this method is a major form of remission induction therapy, which uses chemicals to kill cancer cells in the body. Because chemotherapy drugs destroy many normal blood cells in the process of killing leukemia cells, patients should stay in the hospital during this therapy. This treatment may need to be repeated one or two more times in case the first cycle of chemotherapy doesn't result in remission.

Bone marrow stem cell transplant:
It helps in re-establishing healthy stem cells by replacing unhealthy bone marrow with leukemia-free stem cells that will regenerate healthy bone marrow. This method can be used for consolidation therapy. To destroy the leukemia-producing bone marrow the patient will be given very high doses of chemotherapy or radiation therapy before a stem cell transplant. Afterwards, they will be given infusions of stem cells from a compatible donor (allogeneic transplant). A person’s own stem cells could also be used (autologous transplant) in case they have been in remission and had their healthy stem cells removed and stored for a future transplant.

Other drug therapy:
There are anti-cancer drugs that can be used alone or in combination with chemotherapy for remission induction of a certain subtype of AML called promyelocytic leukemia, such as arsenic trioxide  and all-trans retinoic acid (ATRA).

Prognosis:

Not available

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