Acute Myeloid Leukemia (AML) Understanding the Aggressive Blood Cancer

 

Acute myeloid leukemia (AML), also known as acute myelogenous leukemia, is a type of cancer that affects the blood and bone marrow. It is characterized by the rapid and aggressive progression of abnormal white blood cells, specifically the myeloid cells. AML requires immediate medical attention and treatment due to its fast-growing nature.

Understanding Acute Myeloid Leukemia

AML is classified based on the type of white blood cells affected. There are two main types of white blood cells: monocytes and granulocytes, derived from myeloid stem cells, and lymphocytes, derived from lymphoid stem cells. AML specifically targets the monocyte or granulocyte cells.

Symptoms of AML

The early stages of AML may present symptoms that resemble the flu or other common illnesses. As the disease progresses, the following symptoms may manifest:

1. Pale appearance: AML can cause a person to look pale or "washed out" due to decreased red blood cell production.
2. Fatigue and weakness: Feelings of tiredness and weakness are common symptoms of AML.
3. Shortness of breath: A reduced number of red blood cells can lead to breathlessness.
4. Frequent infections: AML weakens the immune system, making individuals more susceptible to infections.
5. Easy bruising or bleeding: AML can disrupt the normal clotting process, resulting in excessive bruising or bleeding.
6. Unexplained weight loss: AML may cause unintended weight loss without changes in diet or exercise.

If any of these symptoms are experienced, it is important to seek medical advice for proper evaluation and diagnosis.

Seeking Medical Attention

If there is a suspicion of AML, it is crucial to consult a general practitioner (GP) for further assessment. The GP will likely conduct blood tests to analyze the blood cells. If the test results indicate a potential problem, the GP will urgently refer the individual to a hematologist, a specialist in blood conditions, for further tests and treatment.

Causes and Risk Factors

The exact cause of AML is still unknown in most cases. However, certain factors have been identified to increase the risk of developing this aggressive form of leukemia.

Risk Factors for AML

1. Increasing age: The risk of AML rises with age, particularly in adults aged 65 and older.
2. Gender: Men are more likely to develop AML than women.
3. Previous cancer treatment: Certain types of chemotherapy and radiation therapy increase the risk of AML.
4. Exposure to radiation: Individuals exposed to high levels of radiation, such as survivors of nuclear accidents, have an increased risk of AML.
5. Chemical exposure: Exposure to chemicals like benzene, found in cigarette smoke and certain manufacturing processes, is linked to a higher risk of AML.
6. Smoking: AML has been associated with smoking due to the presence of benzene and other carcinogenic substances in cigarette smoke.
7. Blood disorders: People with pre-existing blood disorders, such as myelodysplasia, myelofibrosis, polycythemia vera, or thrombocythemia, are at an elevated risk of developing AML.
8. Genetic disorders: Certain genetic conditions, including Down syndrome, are associated with an increased likelihood of developing AML.

It is important to note that many individuals diagnosed with AML do not have any known risk factors, and having a risk factor does not guarantee the development of the disease.

Diagnosing AML

To diagnose AML, various tests and procedures are conducted to analyze the blood and bone marrow.

1. Physical examination and health history: The doctor will perform a thorough physical examination and inquire about the patient's medical history.
2. Complete blood count (CBC): A blood sample is taken to measure the number of red blood cells, white blood cells, and platelets, as well as the amount of hemoglobin present.
3. Peripheral blood smear: A sample of blood is examined under a microscope to identify blast cells, determine the types of white blood cells present, and assess platelet count and changes in blood cell shape.
4. Flow cytometry: This laboratory test analyzes cells from blood, bone marrow, or other tissues to measure the number, characteristics, and types of cells present. It is particularly useful in diagnosing specific types of leukemia.
5. Bone marrow aspiration and biopsy: A small sample of bone marrow, blood, and bone is collected using a needle inserted into the hipbone or breastbone. The samples are examined under a microscope to detect any signs of cancer.
6. Cytogenetic analysis: This test counts and evaluates the chromosomes in cells obtained from blood or bone marrow. Changes in chromosomes can indicate the presence of cancer.
7. Molecular testing: A laboratory test that checks for specific genes, proteins, or molecules in a blood or bone marrow sample. It can help diagnose AML, determine treatment plans, and assess treatment effectiveness.
8. Immunophenotyping: This test uses antibodies to identify cancer cells based on the antigens or markers present on their surface. It aids in the diagnosis of specific types of leukemia.

Treatment Options for AML

The treatment of AML typically involves two phases: remission induction therapy and postremission therapy.

1. Remission Induction Therapy: The primary goal of this initial phase is to eliminate leukemia cells in the blood and bone marrow, inducing remission. Chemotherapy is the main treatment modality used to achieve this. It involves the administration of drugs that kill cancer cells.
2. Postremission Therapy: Following remission, postremission therapy aims to eradicate any remaining leukemia cells that may not be actively growing but could lead to relapse. The specific treatment approach may vary depending on individual factors such as age and overall health. Options include intensive chemotherapy, radiation therapy, and bone marrow or stem cell transplant.

Other treatment approaches, such as targeted therapy and other drug therapies, are being explored in clinical trials to improve outcomes for individuals with AML.

Support and Resources

Receiving a diagnosis of AML can be overwhelming for patients and their families. Fortunately, there are organizations that offer valuable information, advice, and support:

• Leukaemia Care: Leukaemia Care provides comprehensive support for individuals affected by AML. Their helpline (08088 010 444) and email support (support@leukaemiacare.org.uk) are available to address queries and concerns.
• Cancer Research UK: Cancer Research UK offers detailed information about AML, its diagnosis, treatment, and ongoing research.
• Macmillan Cancer Support: Macmillan Cancer Support provides a wealth of resources and support for individuals diagnosed with AML and their loved ones.

Remember, timely medical intervention and ongoing support are crucial in the journey of AML. With advancements in research and treatment, there is hope for improved outcomes and better quality of life for those affected by this aggressive form of leukemia.