Acute Myelogenous Leukemia

Acute Myelogenous Leukemia (AML) is a cancerous disease that starts in the bone marrow and affects blood cell production. In AML, the bone marrow produces immature and abnormal white blood cells called ‘blasts. These cells rapidly multiply and surround healthy blood cells, including red blood cells, white blood cells, and platelets.

Symptoms & Complications

Its symptoms may vary greatly from person to person, often developing gradually over time. Some of the most common symptoms are:

1- Fatigue & Weakness

Individuals with AML, feel fatigue and weakness, anemia, and shortness of breath because red blood cells are reduced. These cells are responsible for the transport of oxygen throughout the body. Individuals may also experience continuous lethargy, and low energy, and face difficulty in performing daily activities.

2- Frequent Infections

It also weakens the immune system. In affected individuals, the abnormal white blood cells cannot fight infections effectively. This increases the susceptibility to viral, bacterial, and fungal infections. Such individuals may face persistent infections such as sinus infections, skin infections, or pneumonia. If left untreated, it can be life-threatening. 

3- Easy Bruising & Bleeding

Platelets are responsible for blood clotting, and when their number decreases, it can cause bruising, excessive nosebleeds, internal bleeding, and prolonged bleeding from minor cuts and injuries. If not properly managed, it can become dangerous.

4- Bone & Joint Pain

Due to the accumulation of abnormal cells in the bone marrow, MLA can cause bone and joint pain, particularly in the back, hips, and legs. 

5- Fever & Chills

When the body’s immune system is trying to fight the cancer cell, Individuals may also experience unexplained fevers, that are often accompanied by chills or sweating,

6- Unintentional Weight Loss

Despite no significant changes in their exercise and diet routine, some individuals with AML may face sudden weight loss. 

7- Swollen Lymph Nodes

When abnormal cells in AML accumulate in the lymph nodes, they cause the nodes to become enlarged or swollen.

8- Transformation to Acute Lymphoblastic Leukemia (ALL)

In a few cases, AML can transform into a more aggressive form of leukemia called Acute Lymphoblastic Leukemia (ALL). It requires prompt and intensive treatment.

When to See a Doctor

You should consult a doctor if you are experiencing continuous symptoms such as fatigue, frequent infections, sudden weight loss, easy bruising, or bone pain. Early diagnosis and prompt treatment are necessary for effective management of the disease.

At FitwellHub, our experienced oncologists specialize in diagnosing and treating myelogenous leukemia. Book your appointment today and take the first step towards managing your condition effectively!

Acute Myelogenous Leukemia Stages and Progression

Acute Myelogenous Leukemia is generally classified into several phases based on the severity of the disease and the existence of specific chromosomal or genetic abnormalities. Some stages of AML are:

1- Early-Stage AML

In the early stage of AML, abnormal cells called blasts make up less than 20% of the blood or bone marrow.  Individuals may face lighter symptoms and have a better diagnosis. 

2- Intermediate-Stage AML

In this stage, the blasts comprise 20-50% of the blood or bone marrow. Individuals may face acute symptoms and have a more cautious diagnosis.

3- Advanced-Stage AML

 In this advanced stage, the blasts comprise more than 50% of the blood or bone marrow., Individuals may face typically the most severe symptoms and a worse diagnosis.

Causes and Pathophysiology

Although the root causes of Acute Myelogenous Leukemia are still unknown, some researchers have discovered several factors that may cause the development of AML. 

• Genetic Mutations: Certain genetic mutations, such as those in the FLT3, NPM1, and CEBPA genes, are linked to the development of AML. These mutations can disturb normal blood cell production and can cause multiplication of the abnormal cells.
• Environmental Factors: Long-term exposure to toxic chemicals like benzene can cause leukemia. Besides this, the use of chemotherapy or radiation therapy for prior cancer treatment may also increase the risk of developing AML.
• Underlying Medical Conditions: AML most commonly occurs in individuals with specific blood disorders, like chronic myelogenous leukemia or myelodysplastic syndrome.
•  Age: The risk of having AML increases with age. Mostly it occurs in individuals over the age of 60.

According to the pathophysiology of AML, this disease starts in the bone marrow affecting blood cell production. Immature, and abnormal, white blood cells called “blasts” are produced by bone marrow. These cells rapidly multiply and surround healthy blood cells, and can cause several symptoms and complications.

Diagnosis and Prognosis

Diagnosis of Acute Myelogenous Leukemia generally involves several tests and procedures. These include blood tests, bone marrow biopsy, genetic testing, and imaging studies to confirm the presence of leukemia cells. Fitwell Lab provides comprehensive diagnostic services for leukemia, ensuring accurate and timely results.

Blood Tests

A complete blood count (CBC) test detects the presence of abnormal blood cells, such as blasts. A complete blood count (CBC) test detects abnormal blood cells, including blasts..

Bone Marrow Aspiration and Biopsy

In this procedure, a small sample of bone marrow is extracted. This sample is examined under a microscope for the confirmation of the presence and type of leukemia cells.

Genetic Testing

This genetic analysis can detect any chromosomal abnormalities or genetic mutations. It will help make treatment decisions.

When AML diagnosis is confirmed, healthcare providers work to determine the prognosis. The following factors can influence the prognosis of AML:

Factor	Prognosis
Age	Generally better for younger individuals than older adults.
Genetic Mutations	Mutations in genes like NPM1 or FLT3 are linked with a worse prognosis.
Response to Treatment	Better for individuals who respond well to initial treatment, such as chemotherapy.
Overall Health	Individuals with pre-existing medical conditions or a weak immune system may have a worse prognosis.

Treatment Options

For the treatment of Acute Myelogenous Leukemia following therapies are:

1- Chemotherapy

Chemotherapy is the primary treatment for AML, It kills the abnormal leukemia cells and restores normal blood cell production. Different medications are used along with chemotherapy.

2- Targeted Therapy

Some targeted therapy medications target specific genetic mutations or biological pathways that support the survival and growth of AML cells. Its examples include gilteritinib, venetoclax, and midostaurin. 

3- Stem Cell Transplant

A stem cell transplant is recommended for some individuals with AML. In this procedure, the patient’s abnormal blood-forming cells are replaced with healthy stem cells. Allogeneic stem cell transplant uses stem cells from a donor. While autologous stem cell transplant uses the patient’s stem cells.

4- Radiation Therapy

Radiation therapy destroys the leukemia cells, especially if the disease has spread to the central nervous system or other organs.

5- Supportive Care

For AML patients, supportive care is also required with primary treatments. It includes blood transfusions, medications to manage symptoms and complications, and antibiotics to prevent infections. 

Survival Rate & Prognosis

The survival rate varies from one individual to another. According to overall stats, the  5-year survival rate for AML is around 30-35%. The common factors that influence the survival rate and prognosis for AML are:

• Age: Individuals, usually under the age of 60, have a better prognosis, and their 5-year survival rate is about 40-50%. Older people, especially those over 60 years have a weak prognosis, and their 5-year survival rate is around 10-20%.
• Genetic Mutations: Genetic mutations in genes like NPM1 or FLT3 are associated with a worse prognosis. While individuals with beneficial genetic mutations, such as those in the CEBPA or NPM1 genes, may have a better prognosis.
• Response to Treatment: Individuals who do not respond well to initial treatment or have recurring diseases usually have a less favorable prognosis. On the other hand,  the individuals who respond well to initial treatment, achieve complete recovery after chemotherapy and have a better and long-term prognosis. 
• Overall Health: It becomes more challenging to tolerate and respond to AML treatments for individuals already having medical conditions or weak immune systems. It has detrimental effects on their prognosis.

Acute Myelogenous Leukemia in Children

Acute Myelogenous Leukemia most commonly occurs in adults, but it can also be diagnosed in children. AML in children is relatively low, and accounts for approximately 15-20% of all childhood leukemia cases. 

Treatment Approach

For children having AML intensive chemotherapy treatments are used. It is done with the intent of achieving a complete recovery. Stem cell transplant is recommended in some cases, especially for children with high-risk or recurring AML.

Prognosis

Children usually have a better prognosis as compared to adults, with a 60–70% 5-year survival rate. The prognosis varies from person to person depending on several factors like the subtype of AML, the presence of genetic mutations, and the individual’s response to treatment.

Long-Term Effects

Children who have ongoing treatment for AML may face long-term side effects, like memory loss and delayed growth, and may develop secondary cancers. To combat these long-term effects, continuous monitoring and supportive care are crucial. 

Frequently Ask Questions (FAQ’s)