What Is Acute Myeloid Leukemia?
Acute myeloid leukemia (AML) is an aspect of blood cancer that begins in cells which eventually turn into white blood cells. Also, acute myeloid leukemia may begin in other types of blood-forming cells.
Cancer begins when cells in a part of the body start to grow beyond control. We have different types of cancer as cells in nearly any part of the body can grow to become cancer.
AML can also be called the following names:
- Acute myelocytic leukemia
- Acute granulocytic leukemia
- Acute myelogenous leukemia
- Acute non-lymphocytic leukemia
Acute myeloid leukemia usually begins in the bone marrow which is the soft inner parts of human bones. In AML bone marrow don’t actually mature the way they are supposed to as the immature cells keep developing. Blast cells are the other names for the immature cells.
Since AML is regarded as acute, it can spread quickly to the blood and other parts of the body like the liver, brain/spinal cord, lymph nodes, spleen, and testicles. It could be life-threatening if taken for granted without immediate treatment.
However, how AML affects individuals differs as it depends on particular things, not excluding how well this disease responds to treatment. You may experience a better outlook if:
- Your WBC (white blood cell) is reduced when you are being diagnosed
- You don’t have some chromosome changes or gene mutations
- You are below 60 years of age
- You have no history of cancer or blood disorder
Most myeloid cells can grow into red blood cells, platelets, or white blood cells (other than lymphocytes). These myeloid cells are usually the ones that are not normal in AML.
What You Should Do When You Have Acute Myeloid Leukemia
Go for treatment in a cancer center with experienced doctors who are specialized in treating patients with acute leukemia.
Communicate with your oncologist about your diagnostic tests, interpretation of the test results, all your treatment options, and the results you can expect from its treatment. With all these, you are set to enjoy the optimal treatment.
Types Of Blood Cells
We have mainly 3 types of blood cells namely:
Red Blood Cells: This type of blood cell transport oxygen from the lungs to all other tissues in the body, and carbon dioxide is transported back to the lungs for removal from the body.
White Blood Cells: They help fight against diseases in the body. They are different types of white blood cells in the body like granulocytes, lymphocytes, monocytes.
Granulocytes: These are mature white blood cells that develop from myeloblasts which is a type of blood-forming cell in the bone marrow. As the name implies they contain granules that appear as spots under an electron microscope. Granulocytes have 3 types such as neutrophils, basophils, and eosinophils which all differ in their size and color of their granules.
Lymphocytes: They are mature white blood cells that are derived from lymphoblasts in the bone marrow. Lymphocytes are the major cells that makeup lymph tissue which is the main part of the immune system.
Lymph tissues are located around a small organ that is found behind the breast bone known as thymus, lymph nodes, tonsils/adenoids, spleen, and is dispersed throughout the bone marrow, digestive system, and respiratory system. Lymphocytes have 2 types namely B cell and T cells.
Monocytes: This type of white blood cells develops from blood-forming monoblasts in the bone marrow. Monocytes can have its way into body tissues to become macrophages after circulating in the bloodstream for about a day.
Macrophages help destroy some harmful substances by engulfing them. It also helps lymphocytes identify germs and produce antibodies to fight them immensely.
Platelets: They are cell fragments produced in a particular bone marrow known as megakaryocyte. This type of blood helps to arrest bleeding effectively. They help the covering up of holes in blood vessels that are caused by bruises or cuts.
Can Acute Myeloid Leukemia Be Detected Early?
Detecting this cancer in its early stage helps in the effective treatment of the disease. Early detection of particular cancers in patients without any symptoms using screening tests aids treatment effectively according to the American Cancer Society.
Although no screening tests have been identified to help detect AML early and it is advisable to report any known symptoms of acute myeloid leukemia to your medical doctor ASAP.
What Are The Causes And Risk Factors Of This Cancer?
Why someone gets AML is always a huge concern to doctors but some of the risk factors for acute myeloid leukemia are well known to them. Since there is no way to prevent AML, you can reduce your risk of having this cancer by avoiding exposure to chemicals and refraining from smoking. Its risk factors include the following:
- Excessive smoking
- Usage of chemotherapy drugs to treat certain cancers like doxorubicin, mitoxantrone, cyclophosphamide, and melphalan
- People with certain blood disorders like chronic myelogenous leukemia
- When you are exposed to certain chemicals like benzene, detergents, pesticides, some cleaning products, ionizing radiation, and paint strippers
- When you are exposed to high doses of radiation in your body
- Family lineage with the AML
Symptoms Of Acute Myeloid Leukemia
Since AML emanates from the bone marrow which is the sponge-like tissue found inside your bones where blood cells are produced. Acute myeloid leukemia inhibits immature blood cells from developing into healthy blood cells.
During the early stages of AML, as your body produces less healthy blood cells, you might feel like the condition has eased down and you will experience symptoms like fever, loss of weight, feeling of fatigue, loss of appetite, and sweating especially at night.
Although there are some other things which might cause these symptoms, so it is advisable to work hand in hand with your doctor to know the precise cause of it.
We also have symptoms that are associated with subtypes of AML. Each attacks a different kind of blood cell. Your symptoms might depend on the type of blood cell that is affected.
Symptoms Associated With Low Red Blood Cells
If your red blood cells are fewer than normal, you will experience the following symptoms:
- Pale skin
- Feeling dizzy
- Shortness of breath
- Loss of weight
- Abnormal heartbeat
- Cold feet/hands
- Loss of appetite
Symptoms Associated With Low White Blood Cells
If your white blood cells are fewer than normal, you will be prone to infections easily and you’ll experience the following symptoms:
- Feelings of fever
- Pains around your muscles
Symptoms Associated With Low Blood Platelets
If your blood platelets are fewer than normal, you will find it difficult for your blood to clot properly and the following symptoms may surface:
- Bruising very easily
- Bleeding gums
- Uncontrolled bleeding
- Appearance of some red spots on your skin as a result of the bleeding
- Incessant sores that don’t heal
- Heavy menstrual bleeding in women
Symptoms Associated With An Increased Number Of Leukemia Cells
The blasts which are the cancer cells in AML are bigger than normal white blood cells which make it difficult to go through tiny blood vessels. Cells can clog up blood vessels and make it difficult for oxygen and red blood cells to reach the tissues when the blast count is very high leading to what is known as leukostasis. Leukostasis is not common but it’s a medical emergency that needs immediate attention and treatment. Its symptoms are:
- Feeling weak in one side of your body
- Feeling confused
- Having a slurring manner of speech
- Shortness of breath can surface in people whose blood vessels in the lungs are being affected. You can experience blurred vision or loss of vision when the blood vessels in your eye are affected.
Problems Associated With Clotting And Bleeding
People with APL (acute promyelocytic leukemia) which is a type of AML always have bleeding and blood clotting issues as their cut or nosebleed won’t stop gushing out. Sometimes they might experience pains in the chest/shortness of breath from a blood clot in the lungs known as pulmonary embolism and a deep vein thrombosis which is a calf swelling resulting from a blood clot.
Problems Attributed To Joint Or Bone Pain
Some percentage of people with acute myeloid leukemia do experience joint or bone pain as a result of accumulated leukemia cells around that region.
Lump In The Abdomen
A swelling or fullness of your stomach may arise from the large leukemia cells that accumulate in the spleen and liver. It can easily be noticeable by your doctor when feeling with the hands because of its lump around that area which is usually been covered by your lower ribs.
Symptoms Found When Acute Myeloid Leukemia Spreads
Most leukemia cells spread to other parts of the body very easily and the following symptoms may surface:
- Having blurred vision
- Numbed face
- Skin rashes or spots on your skin
- Swollen bleeding gums
- Balance issues
- Pains around your joint or bone
- Swollen belly
- Swelling around your groin, neck, above your collarbone, and underarms
Any of the above signs and symptoms might either be caused by AML or other medical conditions. If you discover the symptoms still persists and doesn’t go away, quickly consult your doctor for optimal treatment.
How Do I Know I Have Acute Myeloid Leukemia (AML)?
Having any of the above symptoms like incessant bleeding or bruising or shortness of breath could indicate you have AML and immediately visit your doctor on seeing any of those symptoms.
You might be asked to see a hematologist or an oncologist who will run some tests to ascertain if you have AML and also know the type in particular you have. The earlier your doctor knows your condition, the better your chance of having a successful treatment.
Your medical doctor will inquire about your health during the physical examination and will also check for any of the signs and symptoms of this cancer in your body.
What Are The Samples Used In Detecting AML?
After you must have explained to your oncologist that you might have leukemia, your blood and bone marrow samples will be collected by him or her to ascertain that you truly have the disease. Sometimes your cell and other tissue samples might be collected as well to know the precise treatment to offer you. Samples usually collected in testing for AML include blood samples, spinal fluid, and bone marrow samples.
Taking your blood samples are usually the first test to perform on a patient to ascertain if he or she has leukemia. Venous blood is usually the best in this aspect.
The brain and spinal cord have a fluid that envelopes it which is the cerebrospinal fluid (CSF). Acute myeloid leukemia can quickly spread to areas around your brain and spinal cord. To ascertain if it’s really AML, your doctor will employ the spinal tap or lumbar puncture method by getting a sample of cerebrospinal fluid for testing
This test does require you to sit up or lie on your side while your doctor numbs an area of your skin on the lower part of your back above the spine. He will then insert a small hollow needle between the bones of your spine into the area around your spinal cord to get some of the fluid.
Delivering chemotherapy drugs into the cerebrospinal fluid is always done with a lumbar puncture to help avert or treat the spread of leukemia to the spinal cord and brain effectively.
Sample Using The Bone Marrow
Employing the use of bone marrow to help check for leukemia cells is actually welcomed since leukemia begins in the bone marrow. Bone marrow samples are achieved from two tests being run concurrently. They include:
Bone marrow aspiration and bone marrow biopsy
Samples from the above tests are usually gotten from the back of the pelvic bone (hip bone), but sometimes other bones could be used in place of the pelvic bone. Samples can only be taken from the breast bone (sternum) if it’s for only an aspiration.
Bone marrow aspiration
You will be asked to lie on a table either on your belly or on your side by your doctor. He will clean the skin over the hip and then numb the region and the surface of the bone using an injectable local anesthetic. You might feel a burning or stinging sensation around that area and a small hollow needle is then inserted into the bone, and a syringe is used to remove a small amount of liquid bone marrow. Irrespective of the anesthetic being applied, most patients still feel some pains whenever the marrow has been removed.
Bone marrow biopsy
This is usually performed immediately after the bone marrow aspiration. A small piece of bone and marrow is being removed with a slightly larger needle being inserted into the bone which might hurt you a little. After the biopsy has been completed, a little pressure will be applied to the area to help arrest bleeding.
The above bone marrow tests help diagnose leukemia accurately and will also be repeated to confirm if the leukemia treatment is working effectively.
How Can You Diagnose AML?
The following tests could be used in testing for immature or abnormal cells in your bone marrow and blood effectively:
- Blood tests
- Bone marrow tests
- Lumbar puncture
- Gene tests
- Imaging tests
A sterile syringe will be used to remove blood from a vein in your arm by your doctor and the following types of blood tests would be used to diagnose AML easily:
Complete blood count (CBC): It is used to know how many red blood cells, white blood cells, and platelets you have. Having more white blood cells and fewer platelets and red blood cells that normal is a clear indication you have AML.
Peripheral blood smear: A microscope is usually used to examine the blood sample in this test. It helps to determine the shape, number, size of white blood cells, and check for immature white blood cells known as blasts.
Bone marrow test
Bone marrow test help confirms you have AML. The medical doctor will insert a needle into a bone usually around your hip and remove a little bit of fluid or a small piece of bone from your body. The sample will then be taken to the laboratory for further testing. A pathologist will examine your cells using an electron microscope and if 20 percent or more of the blood cells in your bone marrow are immature, you may be diagnosed with AML by your doctor.
This test involves the use of sound waves, x-rays, radioactive particles or magnetic fields to create pictures of the inside of the body. Imaging tests are not often useful in diagnosing leukemia since leukemia does not usually produce tumors. But when it’s being used on AML patients, it is more efficient in identifying infections or other problems than detecting leukemia itself. Only in rare cases, imaging tests may be needed to help determine the severity of the disease if it has spread beyond the blood and bone marrow.
This particular test uses sound waves and its echoes to make pictures of masses or internal organs. It can also be used to identify lymph nodes closer to the surface of the body or to check inside your abdomen for swelling lymph nodes or organs like spleen, liver, and kidneys. Ultrasound waves can also be useful in guiding a biopsy needle into an extended lymph node but can’t be used in screening the chest since the ribs might block the sound waves from penetrating.
X-rays are mostly carried out on patients with lung infections.
Computed tomography scan (CT scan)
Most CT scans employ the services of x-rays to make detailed and cross-sectional pictures of your body. In this test, any organs in your body or lymph nodes that are enlarged are easily detected. It is rarely used in diagnosing AML except in cases where your doctor suspect leukemia is erupting in an organ like your spleen.
PET and CT scan: Some machines use the PET scan together with CT scan for effective diagnosis. A form of sugar known as glucose having a radioactive atom is injected into your blood using a PET scan. This helps absorb large amounts of the radioactive sugar since cancer cells in the body develop quickly while using a particular camera to depict the area of radioactivity in your body.
CT-guided needle biopsy: A CT scan may be needed to guide a biopsy needle into an abscess in your body. You may be asked to lie on the CT scanning table while your doctor moves the biopsy needle through your skin and toward the enlarged area. This test is done repeatedly until the needle is within the mass and a sample of the mass is removed and taken to the laboratory to be viewed under an electron microscope.
MRI scan (Magnetic resonance imaging): This type of scan makes detailed images of soft tissues in your body. Magnetic resonance imaging uses strong magnets and radio waves in diagnosing instead of x-rays. They are very important in checking your brain and spinal cord but are not commonly used amongst AML patients.
In this type of test, its cells are subject to chemical stains like dyes that react with only some particular types of leukemia cells in the body. The color change can be found only when viewed under an electron microscope due to the stains added to it to help your doctor know the actual cells that are present
Fluorescent in situ hybridization (FISH): FISH test lay emphasis more on the cell DNA using particular fluorescent stains that only attach to specific chromosomes or genes. In this test, the chromosome changes like the translocations are seen under a microscope in standard cytogenetic tests and some changes that are too minute to be seen with normal cytogenetic testing.
Also, FISH can be conducted using bone marrow samples or regular blood without having to grow them in the laboratory first. This is to show that the results are often ready more quickly than when performed with regular cytogenetic testing.
Cytogenetic analysis and karyotyping
These tests are used to detect certain changes in genes and chromosomes in your body. A polymerase chain reaction (PCR) may be carried out in the laboratory, in which cells in the bone marrow or blood sample are examined to identify certain changes in the structure or function of genes like NPM1 and FLT3.
The diagnosis of acute myeloid leukemia is confirmed by looking out for:
Leukemic blast cells in bone marrow samples
Blast cells percentage as most blasts are usually 1-5% of marrow cells. You must have a minimum of 20% for AML diagnosis to be employed. Even if the blast percentage is less than 20% you can be diagnosed with AML provided the blasts have a chromosome alter that occurs in a particular type of AML.
Antigens on the surface of blast cells like cluster designation (CD13 or CD33)
Cells based on types of antigens on its surface, using a process known as “immunophenotyping”. A particular test may be used to carry out immunophenotyping which is called flow cytometry.
What Are The Treatments For Acute Myeloid Leukemia?
With AML, your bone marrow is being stretched to produce large numbers of abnormal blood cells. These cells envelopes your healthy red blood cells, platelets, and white blood cells. Most AML treatments do destroy unhealthy blood cells in your blood and bone marrow. The main goal here is to improve a patient’s health and make him or her show no symptoms of this cancer.
Here are the optimal treatments for AML:
- Stem cell transplant
- Targeted therapy
Most treatments involve 2 stages namely:
Stage 1: Remission induction therapy: Here you’ll be given high doses of chemotherapy to help destroy as many leukemia cells found in your blood. Most patients are required to reside in the hospital for a minimum of 3 to 5 weeks to help your doctor monitor the effectiveness of the treatment being given to you and treat any side effects you may encounter while undergoing chemotherapy. They are a lot of targeted therapy drugs used.
After successful treatment, your bone marrow should be able to produce healthy blood cells efficiently. The doctor might get a bone marrow sample to check if any leukemia cells are found in your blood. If after checking you don’t have any visible leukemia cells, your doctor will say you’re “in remission” You will still be asked to undergo post-remission therapy to aid you to stay in remission state.
Stage 2: Post-remission therapy: In this stage, more treatments are employed to remove any cancer cells that might have been left behind after the first stage (usually chemotherapy). You may be presented with 3 options to choose from. They include:
You may be given different cycles of high-dose chemotherapy once each month. This involves the use of strong drugs to destroy all cancer cells in your body. These drugs are given usually through the mouth, intravenously, or an injection under your skin. You might be given chemotherapy into the fluid around your brain and spinal cord if the cancer spread. This is usually known as intrathecal chemotherapy by doctors.
Chemotherapy acts by destroying quickly dividing cells in your body. When it destroys these healthy cells, you’ll experience several side effects like:
- Loss of hair
- Constipation and diarrhea
- Easily susceptible to infections
- Sores around the mouth
- Loss of appetite
- Easy bleeding and bruising
Once you are done with your treatment, most of the side effects will seize completely. You can also be given some medications to help curb the side effects of chemotherapy by your doctor.
Stem cell transplant
The higher the dose of chemotherapy you receive, the more cancer cells it will destroy. On the other hand, high-dose chemotherapy can also destroy your bone marrow leading to a rapid decrease in your blood cell levels.
A stem cell transplant will be performed after chemotherapy by your doctor to replace your damaged bone marrow with young stem cells from a donor or your own body. New healthy blood cells will sprout from the stem cells.
We have mainly two types of stem cell transplant namely:
An autologous stem cell transplant: This involves the removal of cells from your own blood or bone marrow before you undergo chemotherapy. These cells will be frozen and then inserted back into your blood after successful treatment. There is a little chance of rejection since the stem cells are gotten from your body. The bad news here is that it is difficult to split leukemia cells from healthy stem cells. Some leukemia cells might be introduced back during the transplant.
An allogeneic stem cell transplant: This is the commonest type of stem cell transplant and is usually taken from a donor. Most at times close relatives like your brother, sister, or parents might be the best match
After a successful transplant, you won’t be allowed to go home so the doctor can watch over you carefully to see how you respond to treatment and any form of side effects will be treated as well. Since this treatment requires you to take high doses of chemotherapy, it brings about serious complications like:
- Causing damage to your bones, lungs, and thyroid gland
- Causes infertility
- Being susceptible to infection easily and bleeding usually from low blood cell counts
- Cataracts (covering the clear outer layer of your eye)
- Another cancer may erupt later
Acute Promyelocytic Leukemia Treatment (APL)
This is a subtype of acute myeloid leukemia that is being treated differently. In this subtype of AML, the leukemia cells contain some proteins that alter the way your blood clots. The leukemia cells are being destroyed during chemotherapy and the protein is released leading to improper blood clotting or severe bleeding in the body.
If you are known to have APL, your doctor will give you some medications to aid your leukemia cells develop into mature, healthy blood cells so they won’t be able to burst and release their protein. The following medications are used in treating acute promyelocytic leukemia (APL):
ATRA (All-trans retinoic acid): These drugs are being given to patients for at least a year or two and it has several side effects like fever, sores around the throat/mouth, high cholesterol, headache, rash, and incessant itching.
Trisenox (Arsenic trioxide): This medication has a lot of side effects like nausea, diarrhea, heart rhythm issues, fatigue, vomiting, pain in the belly, and damage to nerves.
Also, these drugs can be taken alongside chemotherapy.
Radiation employs the usage of high-energy X-rays to kill cancer cells in the human body. AML that has been transferred to your spinal cord and brain or to your bone is performed with radiation. Sometimes radiation can be introduced before a stem cell transplant. An adult AML is usually treated using an external radiation therapy which is given from outside of your body and you may experience the following side effects:
- Sores around your mouth
- Easily susceptible to infections
- Redness of the skin
- If you get radiation to your belly, you’ll experience vomiting, nausea, and diarrhea
- Bruising or bleeding
Clinical Trials Associated With Acute Myeloid Leukemia
Clinical trials can be employed where your AML treatment stops working, or the treatment doesn’t work for you and your cancer starts growing again.
In clinical trials, researchers test new treatments to see if it will be effective. Most doctors carry out clinical trials on their patients and may inform them about the pros and cons and if successful, you will be told on how to sign up and use the clinical trials.
Best Hospitals For Treating Acute Myeloid Leukemia In The U.S.
The following are some of the best hospitals you could get treated for AML effectively in the U.S.
Mayoclinic under AML center
Dana-Farber Cancer Institute, Boston, M.A
City of Hope Hospital, Southern California
St. Jude Children’s Research Hospital, TN 38105
Having known what acute myeloid leukemia (AML) is and how you could treat it, it is advisable to take good care of your overall health and do away with some unhealthy lifestyles like excessive smoking and drinking of alcohol as acute myeloid leukemia cannot be prevented.
Also, AML can be classified into subtypes using two main systems known as the newer World Health Organization (WHO) and the French-American-British classification (FAB) which is classified from M0 through M7 according to the special cells leukemia develops from/how mature the cells are in your body.
Consequently, the WHO classifies AML into groups namely:
AML associated with certain genetic abnormalities like chromosomal and gene changes
AML that deals with myelodysplasia issues changes
Acute myeloid leukemia with previous radiation or chemotherapy
AML that is not otherwise specified into any of the above groups like the AML with minimal differentiation (FAB M0) and acute panmyelosis with fibrosis
Myeloid sarcoma sometimes called chloroma or granulocytic sarcoma
Myeloid proliferations associated with Down syndrome
Undifferentiated and biphenotypic acute leukemias (BPALs) aren’t actually AML but are leukemias having both myeloid and lymphocytic features. They can also be known as MPALs (mixed phenotypic acute leukemias). Why not share this enriching article to help your friends and loved ones with AML enjoy a healthy life?