Acute Myelogenous Leukemia
Definition of Acute Myelogenous Leukemia (AML)
Acute myelogenous leukemia: Abbreviated AML. Also called acute myeloid leukemia or acute nonlymphocytic leukemia (ANLL). Dangerous disease which advances very quickly where there are too many blood-forming cells are immature / mature in the blood and bone marrow, cells that are specifically intended to give rise to granulocytes or monocytes, both types of white blood cells that fight infections. In AML, blast-blast is not mature and thus become too much. AML can occur in adults or children.
Signs and Symptoms of AML
Early signs of AML may be similar to flu or other common diseases with fever, weakness and fatigue, loss of weight and appetite, and aches and pains in bones or joints. Other signs of AML may include signs of a little red on the skin, easy bruising and bleeding, often minor infections, and poor healing of minor cuts.
First, blood tests are done to count the number of each type of blood cells are different and see whether they are within normal limits. In AML, the levels of red blood cells may be low, causing anemia; platelet levels may be low, causing bleeding and bruising; and the levels of white blood cells may be low, leading to infections.
Bone marrow biopsy or aspiration (suction) of bone marrow may be performed if the results of blood tests are abnormal. During a bone marrow biopsy, a hollow needle is inserted into the hipbone to issue a small amount of marrow and bone for testing under the microscope. In bone marrow aspiration, a small sample of bone marrow is withdrawn through the injection liquid.
Lumbar puncture, or spinal tap, may be performed to see whether the disease has spread into the cerebrospinal fluid, which surrounds the central nervous system or central nervous system (CNS) - brain and spinal cord.
Diagnostic tests may include other key flow cytometry (which cells are passed through a laser beam for analysis), immunohistochemistry (using antibodies to differentiate between types of cancer cells), cytogenetics (to determine changes in chromosome in the cells), and molecular genetic studies (tests of DNA and RNA from cancer cells).
Primary treatment of AML is chemotherapy. Radiation therapy is less common: it may be used in certain cases. Bone marrow transplantation is under study in clinical trials and is being increasingly used.
There are two phases of treatment for AML. The first phase is called induction therapy (induction therapy). The goal of induction therapy is to kill as many leukemia cells and induce a remission, a state where there is no visible evidence of disease and normal blood counts. Patients may receive a combination of drugs during this phase including daunorubicin, idarubicin, or mitoxantrone plus cytarabine and thioguanine. Once in remission with no signs of leukemia, patients enter a second phase of treatment.
The second phase of treatment called post-remission therapy (or continuation therapy). He designed to kill leukemia cells remaining. In the post-remission therapy, patients may receive a dose of high-dose chemotherapy, designed to eliminate any leukemia cells remaining. Treatment may include a combination of cytarabine, daunorubicin, idarubicin, etoposide, cyclophosphamide, mitoxantrone, or cytarabine.
There are a number of different subtypes of AML. AML is classified using a system called the French American British (FAB) system. In this system, the subtypes of AML are grouped according to certain cell lines in which the disease develops. There are eight different types of AML, designated as M0 to M7. Types of M2 (myeloblastic leukemia with maturation) and M4 (myelomonocytic leukemia), each responsible for 25% of AML; M1 (myeloblastic leukemia, with little or no mature cells) are responsible for 15%; M3 (promyelocytic leukemia) and M5 (monocytic leukemia), each responsible for 10% of cases; other subtypes are rarely seen. AML is also classified according to chromosomal abnormalities in cells that are dangerous.
Treatment of the subtype of AML called acute promyelocytic leukemia (APL) differs from that for other forms of AML. (APL is M3 in the FAB system.) Most APL patients are now treated first with all-trans-retinoic acid (ATRA) which induces a full response in 70% of cases and prolong survival. APL patients was then given a series of consolidation therapy, which may include cytosine arabinoside (Ara-C) and idarubicin.
Bone marrow transplants are used to replace bone marrow with healthy bone marrow. First, all the bone marrow in the body is destroyed with a dose-high dose chemotherapy with or without radiation therapy. Healthy marrow is then taken from another person (donor) whose tissue is the same or nearly the same as yours patient. Donors may be you twin (the best match), a brother or sister, or someone who is related or not related. A healthy marrow from the donor is given to the patient through a needle into the vein, and the marrow replaces the marrow that was destroyed. Bone marrow transplant using marrow from a brother or sister of someone who is not called allogeneic bone marrow transplant. Greater opportunities for recovery occurs if the doctor choose the hospitals that performed more than five times the bone marrow transplants per year.
Overall chance of recovery (long-term prognosis) depends on the subtype of AML and the age and overall health of the patient.
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