Acute Myeloid Leukaemia (AML)
Acute Myeloid Leukaemia (or Acute Myeloblastic Leukaemia or AML) is a type of blood cancer. Under normal conditions the bone marrow produces cells called myeloblasts which mature into granulocytes. These cells are charged with the defence of the organism against infections.
In AML the myeloblasts are produced in excess and they do not evolve into granulocytes. The myeloblasts gradually invade the bone marrow, displacing the normal blood cells and other organs and tissues (liver, spleen, skin, nervous system, etc.). The causes of AML, like all leukaemias, are not known. However, its manifestation has been linked to the exposure to ionized radiation, chemical products and chemotherapy treatment. In other cases AML is the final stage of another disease such as myelodysplastic syndrome and myeloproliferative syndrome. There is an elevated risk for patients suffering from other complications such as Down's syndrome or Fanconi's Anaemia.
AML is a disease that affects adults (the average age is 65 years old) although on occasions there have been cases in children. This type of leukaemia represents 40% of all leukaemias in the western world. The level of new cases is estimated at 15 per million inhabitants each year.
Meet Bianca, an Acute Myeloid Leukaemia patient.
Main Symptoms
The symptoms of AML are a consequence of the anaemia produced by the deficit of red blood cells (sensation of tiredness, weakness, dizzyness, paleness); the deficit of platelets (bruising, bleeding gums, and nose and any other source); and the deficit of granulocytes (fever and infections). Occasionally, a growth in the lymph glands, liver, or spleen can be seen. Specific symptoms can also manifest which signify the infiltration of the central nervous system (headache, vomiting, drowsiness, etc.), the skin (nodules or scattered areas of thicker skin), the mucosa membrane (inflammation of the gums), the eyes (blurred vision, blindness), among others.
Meet María, an Acute Myeloid Leukaemia patient.
Study
To establish a diagnosis for AML it is necessary to carry out a thorough blood and bone marrow exam, to be analysed under a microscope. There are distinct forms of AML that each require distinct therapeutic approaches. Once the diagnosis has been made, further blood and bone marrow tests should be carried out in order to determine the specific characteristics of the leukaemia. For that reason it is necessary to carry out several blood and bone marrow samples (taken through a puncture in the sternum or hip bone). Equally, a lumbar puncture will be necessary in order to analyse the liquid that circulates the nervous system and to establish the extent of the disease in the organism.
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Treatment
The treatment of Acute Myeloid Leukaemia depends on the prognosis group to which the patient is assigned, which will be based on age, the leukaemia cell count and their characteristics. Apart from Acute Promyelocytic Leukaemia, a specific subtype of AML, in which the treatment combines the association of chemotherapy with a mature agent called ATRA, all other forms of AML require treatment based on intense chemotherapy.
Meet Maite, an Acute Promyelocytic Leukaemia patient.
Chemotherapy consists of two phases. In the first, the induction, the aim is to eliminate the highest possible amount of leukaemia cells and completely reduce the symptoms. This situation is called a complete remission, which is normally reached after one or two cycles of chemo. The second phase is called intensification or consolidation, and consists of one or two further cycles of chemo in order eliminate any leukaemia cells that might have been hidden in the organism.
In patients who are deemed a high risk of relapsing it will be necessary to complete the treatment with a bone marrow transplant from a compatible donor (allogeneic transplant) or themselves (Autologous transplant) (please see the "transplants" section).
The prognosis of the disease varies depending on the specific subtype of leukaemia and the response to the treatment.
For more information, please consult the following web pages:
• National Cancer Institute
• Fundación Leucemia y Linfoma
• Enciclopedia Médica Medline Plus
• "Leucemia mieloide aguda: Guía para pacientes y las personas que los cuidan", resource of The Leukaemia & Lymphoma Society
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