Introduction
Acute Myeloid Leukemia (AML) is the most common type of acute leukemia, a rapidly progressing cancer that affects the blood and bone marrow, making early diagnosis and treatment critical. In AML, the bone marrow starts producing immature cells called blasts, which normally develop into white blood cells. However, these blasts fail to mature and cannot fight infections. In addition to producing abnormal white blood cells, the bone marrow also generates abnormal red blood cells and platelets. As the number of abnormal cells rapidly increases, they crowd out healthy blood cells, impeding their function. AML can quickly spread into the bloodstream and may spread to other parts of the body, including the lymph nodes, spleen, liver, central nervous system (brain and spinal cord), and testicles.
There are several subtypes of AML, with acute promyelocytic leukemia (APL) being one notable example. APL occurs due to a genetic mutation where genes on chromosome 15 swap places with genes on chromosome 17, altering normal cell function.
Symptoms of AML
The early symptoms of AML often resemble those of the flu or other common illnesses, which can make it challenging to diagnose in its initial stages. Common symptoms include:
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Weakness or fatigue
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Fever
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Frequent infections
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Pale skin or loss of normal skin color
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Unusual bleeding or bruising
Diagnosis Tests for AML
Several tests are used to diagnose AML, often starting with a review of your personal and family medical history. Here are key diagnostic tools:
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Complete Blood Count (CBC): This test checks your blood for the number of red and white blood cells, platelets, hemoglobin levels (which carry oxygen in the blood), and hematocrit (the proportion of blood made up of red blood cells). In AML, these values are often abnormal due to the overproduction of immature white blood cells.
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Peripheral Blood Smear: A sample of your blood is examined under a microscope to detect blast cells, assess the number and types of white blood cells, and identify any abnormalities in blood cell shape.
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Flow Cytometry: This advanced blood test measures the number and percentage of living cells, assessing their size, shape, and surface markers. Cells from the blood sample are stained with a fluorescent dye and passed through a laser beam to determine how the cells react to the light. This test is vital for diagnosing leukemia and other cancers by identifying specific characteristics of the cancer cells.
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Cytochemistry: In cytochemistry tests, cells are treated with chemical dyes that react with specific types of leukemia cells, producing visible color changes under a microscope. For instance, certain dyes can distinguish AML cells from ALL (Acute Lymphoblastic Leukemia) cells by highlighting granules in AML cells, which appear as black spots, while ALL cells remain unaffected.
Additional Tests and Subtype Classification
If you're diagnosed with AML, further tests will likely be conducted to determine the spread of the cancer and classify it into a specific AML subtype. This classification is crucial for developing an effective treatment plan. The subtype is identified based on how the cancer cells appear under a microscope and through specialized lab tests that detect the unique characteristics of the leukemia cells.
Treatment for AML
Treatment for AML depends on factors such as the specific subtype of the disease, your age, and your overall health. Generally, treatment occurs in two phases:
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Remission Induction Therapy: The primary goal of this initial phase is to eliminate leukemia cells from the blood and bone marrow. While this phase aims to put the cancer into remission, it typically doesn't destroy all the leukemia cells, so further treatment is necessary.
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Consolidation Therapy: Also known as post-remission or maintenance therapy, this phase aims to eliminate any remaining leukemia cells to reduce the risk of relapse.
Key treatments used during these phases include:
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Chemotherapy: Chemotherapy is the mainstay of both remission induction and consolidation therapy. It involves the use of potent drugs to kill leukemia cells. Due to its intensity, chemotherapy often requires hospitalization as it can destroy healthy blood cells alongside the cancer cells. If the first round of chemotherapy doesn’t induce remission, additional cycles may be necessary.
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Targeted Therapy: Targeted therapies focus on specific genetic abnormalities in leukemia cells, blocking these abnormalities to cause the cancer cells to die. Your leukemia cells will be tested to determine whether targeted therapy could be beneficial. This treatment can be used alone or in combination with chemotherapy during both induction and consolidation therapy.
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Bone Marrow Transplant (Stem Cell Transplant): In consolidation therapy, a bone marrow transplant may be performed to replace the diseased bone marrow with healthy, leukemia-free stem cells. Before the transplant, high doses of chemotherapy or radiation therapy are administered to destroy the leukemia-producing bone marrow. Following this, healthy stem cells—either from a donor (allogeneic transplant) or, in some cases, your own previously collected stem cells (autologous transplant)—are infused to regenerate healthy bone marrow.
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Clinical Trials: Some patients choose to participate in clinical trials that explore new or experimental treatments. Clinical trials can provide access to cutting-edge therapies that may not yet be widely available, but it's important to discuss the potential risks and benefits with your doctor.
Conclusion
Acute Myeloid Leukemia is a rapidly progressing cancer that requires prompt diagnosis and treatment. The disease's complexity, including its various subtypes and the rapid growth of abnormal cells, makes it critical to understand your specific diagnosis and treatment options. Collaboration with healthcare providers, along with careful consideration of available therapies, can greatly improve outcomes for those battling AML.