What is Acute Myeloid Leukemia (AML)?
Acute myeloid leukemia is a type of blood cancer. This starts in the myeloid cells of the bone marrow that differentiate into various white blood cells. If not treated early the progression of Acute myeloid leukemia is very fast.
The condition is also known as acute myelocytic leukemia, acute myelogenous leukemia, acute granulocytic leukemia, and acute non-lymphocytic leukemia. The disease usually originates in the bone marrow and then moves into the blood. It can also spread to the lymph nodes, liver, spleen, brain spinal cord and testicles.
In acute myeloid leukemia there is an increase in the number of white blood cells called collectively as granulocytes. The various types of granulocytes are neutrophils, basophils and eosinophils. These cells develop from a type of cells in the bone marrow called myeloblasts. In acute myeloid leukemia the cells formed are immature and abnormal. The leukemic cells cannot carry out the functions of normal white blood cells which is mainly to resist infections.
Acute myeloid leukemia usually occurs in the elderly. The disease is rarely seen in those below the age of forty five. The average age of occurrence is about seventy years. Men are slightly more likely to develop the disease than women. The condition of the sufferer can worsen fast if treatment is not initiated early.
The symptoms of Acute Myeloid Leukemia are related to a decrease in the number of healthy white blood cells. Symptoms can also occur due to a decrease in the number of platelets and red blood cells. This usually happens when the immature leukemic cells crowd out the normal white and red cells as well as platelets.
The symptoms can be classified according to the nature of blood cell affected. The early stage symptoms are:
• Constant Tiredness
• Recurrent fever
• Loss of appetite
• Unexplained weight loss
• Frequent night sweats
These symptoms often resemble those of other diseases. A detailed investigation is necessary to arrive at a diagnosis.
Symptoms due to a decrease in the number of red blood cells:
• Paleness of the skin
• Irregular heartbeats
• Coldness of the extremities
• Shortness of breath on exertion
• Frequent Headaches
Symptoms due a decrease in the number of healthy white blood cells:
• Recurrent infections
• Muscular pain
Due to decrease in platelet levels:
• Tendency to bruise easily
• Uncontrolled bleeding from small cuts or wounds that can be hard to stop
• Bleeding gums
• Bleeding from the nose
If the disease has spread to other parts of the body, the symptoms will include
• Problems with balancing the body
• Blurring of vision
• pain in the bones or joints
• Numbness of face
• Sudden seizures
• Spots or a rash on your skin
• Swelling in the abdomen
• Swollen glands in the neck, groin, underarms, near the collarbone etc
The exact cause of the disease is not clear. Certain mutations or changes in the genes are thought to be the reason. But what exactly causes these changes is again not fully understood.
There are certain factors that increase the risk of getting the disease. These include:
• exposure to chemicals like benzene, formaldehyde etc
• Previous history of chemotherapy
• History of radiotherapy
• Exposure to radiation
• Certain blood disorders like myelodysplastic syndrome, polycythemia vera, idiopathic myelofibrosis etc
• Genetic syndromes like Fanconi anemia, Bloom syndrome, Ataxia-telangiectasia, Li-Fraumeni syndrome, Neurofibromatosis, congenital neutropenia etc.
AML treatment in India
The most common mode of treatment for AML is chemotherapy. Other treatments include targeted therapy and bone marrow transplant. The treatment is decided according to the sub-type of the disease. The sub-type is decided by analysing the shape and properties of the leukemic cells.
The treatment of AML is divided into two phases. They are:
Remission induction therapy- the aim of this treatment phase is to destroy and eliminate the leukemic cells from the blood and bone marrow. In this phase as much of the leukemic cells as possible are destroyed by using chemotherapeutic drugs.
Consolidation therapy-This phase of treatment is also called as post-remission therapy, maintenance therapy or intensification. The remaining leukemic cells present in the blood and bone marrow is destroyed during this phase of treatment. This helps to prevent the chances of a relapse. Therapies used in these phases include:
Chemotherapy- this is the most preferred mode of treatment during remission induction therapy. It may also be used for consolidation therapy. Chemotherapy uses certain drugs to kill cancer cells. Chemotherapy drugs are given as pills or intravenous infusions. The treatment is given in cycles with a period of rest in between. The treatment can cause certain transient undesirable side effects.
Bone Marrow transplant: Bone marrow transplant is effective in treating certain types of AML. Prior to a bone marrow transplant, the diseased bone marrow is removed through chemotherapy and radiation. A healthy bone marrow sourced from a donor or self is then transferred into the bone marrow spaces. This healthy bone marrow then starts producing normal blood cells. A bone marrow transplant procedure is a complex one and requires an extended stay in the hospital. Anti-transplant rejection medicines will have to be taken for the rest of one’s life. Since these medicines tend to decrease the immunity of the body, care must be taken to avoid infections.
Acute Myeloid Leukemia survival rate in India
The average five year survival rate for acute myeloid leukemia is about 30% with proper treatment. A delayed administration of treatment can decrease the survival chances considerably. Also the subtype of the disease is an important factor for prognosis. Certain subtypes respond more favourably to the treatment than others.