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ADULT ACUTE MYELOID LEUKEMIA

Adult acute myeloid leukemia (AML) is a type of cancer in which the bone marrow makes abnormal myeloblasts (a type of white blood cell), red blood cells, or platelets.

Adult acute myeloid leukemia (AML) is a cancer of the blood and bone marrow. This type of cancer usually gets worse quickly if it is not treated. It is the most common type of acute leukemia in adults. AML is also called acute myelogenous leukemia, acute myeloblastic leukemia, acute granulocytic leukemia, and acute nonlymphocytic leukemia.

In AML, the myeloid stem cells usually develop into a type of immature white blood cell called myeloblasts (or myeloid blasts). The myeloblasts in AML are abnormal and do not become healthy white blood cells. Sometimes in AML, too many stem cells develop into abnormal red blood cells or platelets. These abnormal white blood cells, red blood cells, or platelets are also called leukemia cells or blasts. Leukemia cells can build up in the bone marrow and blood so there is less room for healthy white blood cells, red blood cells, and platelets. When this happens, infection, anemia, or easy bleeding may occur. The leukemia cells can spread outside the blood to other parts of the body, including the central nervous system (brain and spinal cord), skin, and gums.

Risk factors for adult AML

  • Being male
  • Smoking, especially after age 60
  • Having had treatment with chemotherapy or radiation therapy in the past
  • Having had treatment for childhood acute lymphoblastic leukemia (ALL) in the past
  • Being exposed to atomic bomb radiation or the chemical benzene
  • Having a history of a blood disorder such as myelodysplastic syndrome

Symptoms of adult AML

  • Fever
  • Shortness of breath
  • Easy bruising or bleeding
  • Petechiae (flat, pinpoint spots under the skin caused by bleeding)
  • Weakness or feeling tired
  • Weight loss or loss of appetite

Diagnostic tests and exams for adult AML

  • Physical exam and history including checking for signs of disease, such as lumps or anything else that seems unusual
  • Blood test for complete blood count (CBC)
  • Blood chemistry studies to measure the amounts of certain substances released into the blood by organs and tissues in the body
  • Peripheral blood smear to check for the presence of blast cells, number and kinds of white blood cells, the number of platelets, and changes in the shape of blood cells
  • Bone marrow aspiration and biopsy
  • Cytogenetic analysis to look for certain changes in the chromosomes
  • Immunophenotyping to diagnose the subtype of AML by comparing the cancer cells to normal cells of the immune system
  • Reverse transcription - polymerase chain reaction test (RT-PCR) to look for certain changes in the structure or function of genes

Treatment of adult AML

Treatment options depend on:

  • Patient`s age
  • AML subtype
  • Whether the patient received chemotherapy in the past to treat a different cancer
  • Whether there is a history of a blood disorder such as myelodysplastic syndrome
  • Whether the cancer has spread to the central nervous system
  • Whether the cancer has been treated before or recurred (come back)

The treatment of adult AML usually has 2 phases:

  • Remission induction therapy: This is the first phase of treatment. Its purpose is to kill the leukemia cells in the blood and bone marrow. This puts the leukemia into remission.
  • Post-remission therapy: This is the second phase of treatment. It begins after the leukemia is in remission. The purpose of post-remission therapy is to kill any remaining leukemia cells that may not be active but could begin to regrow and cause a relapse. This phase is also called remission continuation therapy.

Treatment options used for adult AML are:

  • Chemotherapy: Use of drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
  • Radiation therapy: Use of high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Can be external radiation therapy or internal radiation therapy.
  • Chemotherapy with stem cell transplant: Stem cell transplant is a method of giving chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body`s blood cells.
  • Other drug therapy: Arsenic trioxide and all-trans retinoic acid (ATRA) are anticancer drugs that kill leukemia cells, stop the leukemia cells from dividing, or help the leukemia cells mature into white blood cells. These drugs are used in the treatment of a subtype of AML called acute promyelocytic leukemia.

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