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  Acute myeloid leukemia

Adult acute myeloid leukemia is a serious cancer of the blood. This disease is also referred to as acute myelogenous leukemia. This leukemia is specifically a cancer of the myeloid line of white blood cells. This leukemia is characterized by the swift increase of abnormal cells that build up in bone marrow and disrupt normal cell production. Acute myeloid leukemia is the greatest occurrence of leukemia types in the adult leukemia population. Adult acute myeloid leukemia is rare – approximately one percent of cancer deaths in the United States are caused by AML.

Acute myeloid leukemia
Acute myeloid leukemia


Symptoms:

In order to understand the symptoms of acute myeloid leukemia, it is important to comprehend what is occurring in the body. The numbers of leukemic or malignant white blood cells are interrupting the normal system of the body. Blood cells are produced in bone marrow and the body has a natural balance of the numbers of the types of blood cells produced. Without normal white blood cells, a person is highly susceptible to infection. Leukemic cells, though created from cells destined to be white cells, have no infection defense or fighting power. The crowding of leukemic cells causes a lack of red blood cells and platelets. The lack of red blood cells causes shortness of breath (with little exertion), pallor, tiredness, and overall muscle fatigue. The drop in platelets causes unusual and easy bruising and bleeding.

The overall signs of acute myeloid leukemia mimic the flu and other common illnesses. These ‘shared’ symptoms are fever, tiredness, unexplained loss of weight, shortness of breath, easy bruising, bleeding and flat pin-head sized red marks right under the skin

In some patients the spleen can become enlarged- but usually not to a noticeable degree. The skin can be a part of symptoms and signs of AML via a syndrome called Sweets – which is a very rare paraneoplastic (degenerative) inflammation of the skin.

Another symptom in patients of acute myeloid leukemia may be swelled gums. This sign of leukemia is due to the build up of leukemic cells in the tissue. A rare first sign or symptom may be the development of a mass or tumor that is a solid collection of leukemic cells outside of the bone marrow. This mass is called a chloroma or granulocytic sarcoma.

Diagnosis:

Acute myeloid leukemia is first indicated via an abnormal result in the blood count. A blood count is a determination of the ration of various blood cells. An excess of leukocytes – white blood cells is the first indicator of AML. Other indicators in the blood – even with a low white blood cell count are lower counts or decreases in platelets and red blood cells

Unequivocal diagnosis of acute myeloid leukemia is made by examining the bone marrow of the patient. A bone marrow biopsy involves the aspiration or removal of a small portion of bone marrow and possible bone with a needle. If the blood sample contains a high number of leukemic cells then bone marrow examination is not required for a diagnosis. Marrow should be examined for the classification of type of leukemia. This is important in choosing the correct path of treatment.

Classification of acute myeloid leukemia should be done by a certified, experience hemato-pathologist or a hematologist. The World Health Organization (WHO) criteria for the diagnosis of acute myeloid leukemia is the presence of more than twenty percent of leukemic myeloblasts in the blood or bone marrow sample. It is necessary to determine if AML is not a pre-leukemic condition, which would require a different course of treatment.

Acute promyelocytic leukemia has the highest rate of cure and requires a specific treatment course. It is imperative to determine if this is the subtype of leukemia the patient has. The chromosomal translocation t(15:17) is the marker for this sub type of leukemia.

Classification:

There are two methods recognized for classification of acute myeloid leukemia. The older method is known as the French-American-British FAB Method. The more recent classification has been established by the World Health Organization (WHO). FAB classification divides AML into subtypes M0 through M7. This typing is based on the type of cell from which the leukemia develops and the level of maturity the cell has reached. The WHO classification of AML also looks at the genetic/chromosomal mutation of the leukemic cells. There are five subtypes in the WHO classification.

Treatment:

Treatment for AML is mainly through chemotherapy. There are two phases of treatment for AML. The first phase is induction therapy; the second phase is post-remission or consolidation therapy. Treatment is based on the sub type of acute myeloid leukemia, with a particular concern of the chromosomal abnormality. Induction therapy is aimed at achieving a total remission. Remission is when leukemic cells are at an undetectable rate in the blood/bone marrow. Consolidation therapy is aimed at removing and obliterating any lingering leukemic cells – to achieve a cure.

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