Acute Myeloid Leukemia (Adult)

Description

There are two major types of leukemia: lymphocytic leukemia, which involves lymphoid-committed cells that form and mature in the lymphatic system, and myelogenous leukemia, which affects myeloid-committed cells that form and mature in the bone marrow. In medical terminology, the root "myelo" always refers to bone marrow.

Each of these types can occur in either the acute or chronic form. The acute form affects young cells still involved in the growth process that divide quickly and hasten the progress of the disease. The chronic form involves more mature cells that have stopped dividing or do so at a relatively slow rate.

There are two major subdivisions in adult leukemias, with the identification of the various forms based on the appearance of the cells and on studies of various biological and cell surface markers. Chromosome analysis often helps to identify the type of leukemia involved.

Eighty percent of adult patients have an acute myeloid (AML) form. Acute myelogenous leukemia (AML) is chiefly an adult disease with a median age at presentation of 50. The rate of incidence increases with age. AML is subdivided into many subtypes such as acute myelogenous or myeloblastic, acute monocytic or monoblastic (AMOL), acute myelomonocytic (AMML), and acute promyelocytic (APL).

Causes and Risk Factors

Experts believe that certain people may be susceptible to getting leukemia, and that if these people are exposed to cancer-causing agents (carcinogens), leukemia may result. The causative factors may include age, exposure to radiation, genetics, chemicals, and cancer therapy. Workers with long-term exposure to benzene have a risk of acute leukemia estimated to be 20 times higher than the general population. People who undergo certain types of chemotherapy and radiation therapy for other cancers run a risk of developing leukemia.

Symptoms

Most patients have been ill for days or weeks. Patients may present with fatigue, fever and recurrent infections, weight loss, night sweats, or bleeding.

Diagnosis

Although suspected by medical history or physical examination, leukemia may be diagnosed incidentally when blood tests or radiological studies are performed for other indications.

A bone marrow biopsy may also be recommended by your physician.

Treatment

Leukemia is treated mainly with chemotherapy, although radiotherapy and biological therapy can play a part with some forms of the disease. The goals of therapy are to relieve symptoms and obtain a remission. Remission is the condition in which leukemia is no longer detected and the bone marrow functions normally.

Treatment of leukemia, in general, is usually divided into two phases:

1. Induction. This is the attempt to attain a remission meaning that the bone marrow appears normal.

2. Consolidation. This involves giving the same or different treatment, even when the patient appears to be in remission because of the suspected or assumed presence of residual disease that cannot be detected.

Some patients may receive a third phase called maintenance treatment to prolong the remission. Maintenance treatment is more associated with the treatment of ALL (Acute Lymphoblastic Leukemia) than AML (Acute Myelogenous Leukemia).

Standard treatment for acute myeloid leukemia includes two drugs: Daunomycin (daunorubicin) and Cytosar (cytosine arabinoside). These are commonly given intravenously.

These drugs may cause significant nausea and vomiting, so patients are also given drugs such as Benadryl, Compazine, Vistaril, Reglan, and Ativan.

The chemotherapy drugs will kill normal and leukemic cells equally, so the most significant side effect besides nausea and vomiting is a temporary reduction of normal white blood cells and platelets. The deficiency of white cells means a loss of normal defenses against bacterial and fungal organisms leaving the patient open for infections. Low platelets mean that the patient may bruise or bleed easily. All patients are closely watched in the hospital until this effect is over.

Supportive treatment during the period of bone marrow recovery (after chemotherapy) includes blood and platelet transfusions and intravenous antibiotic treatment. Because of the intensive supportive treatment required, therapy for AML is often given in the hospital.

After remission is achieved, post-remission therapy can be curative. Options include repeated intensive chemotherapy with or without bone marrow transplantation, and high dose chemoradiotherapy with bone marrow transplantation.

Questions to Ask Your Doctor

What tests need to be done to accurately diagnose the condition? Are there any side effects to these tests?

Should a specialist be seen?

What treatment will you be recommending? How successful is this treatment?

Will you be prescribing any medication? What are the side effects?

Can some of the side effects be controlled?

Will the blood cells and platelet count return to normal after treatment?

What is the prognosis of this type of leukemia?