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Acute Myeloid Leukaemia (AML) is a type of cancer, in which there is excess production of myeloid cells in the bone marrow. Acute myeloid leukaemia accounts for approximately 3% of all cancers in India, where the highest risk age is 32 years. Although it can affect individuals of any age or gender, its incidence is found more with progressing age (80% to 90%) and in males .
AML often leads to conditions, such as anaemia, granulocytopenia, and thrombocytopenia. Being acute in nature, this type of cancer spreads rapidly in individuals, developing within just a few weeks. If left untreated, AML can lead to complete dysfunction of bone marrow and even death. Therefore, it is important to be aware of its symptoms to get diagnosed and treated at the earliest.
|Symptoms||Weight loss, weakness, anaemia, pale skin, infections, such as neutropenia, heavy menstrual bleeding in women, bone or joint pain, enlarged lymph nodes, etc.|
|Complications||Weakened immune system, infertility, internal bleeding, etc.|
|Causes||The exact cause is unknown.|
|Onset||Starts in the bone marrow and spreads to the rest of the body.|
|Diagnosis||Blood tests, bone marrow tests, molecular tests, immunophenotyping, etc.|
|Prevention||Avoiding tobacco, chemical benzene, high radiation, etc.|
|Medication||Induction chemotherapy, radiotherapy, stem cell transplant, etc.|
Here is a detailed overview of AML, its symptoms, causes, types, complications, treatment and prognosis.
Acute myeloid leukaemia symptoms start developing after a few weeks from the onset of the condition. Its symptoms vary widely depending on the severity of the case, and with the increase of leukaemia cells and a decrease in the number of red and white blood cells.
Here is the list of AML symptoms at each phase of the condition :
1. General Symptoms
The most common symptoms that individuals with AML often experience are the following:
2. Symptoms Due to Low Red Blood Cell Counts
As the total count of red blood cells decreases, there is low oxygen transport to the cells, giving rise to the following symptoms:
3. Symptoms Due to Low White Blood Cell Counts
White blood cells, such as neutrophils, fight against foreign bodies to prevent infections. Therefore, a reduction in the white blood cell counts may cause:
4. Symptoms Due to Low Blood Platelet Counts
Platelets help to stop bleeding. Therefore, a reduced number can cause thrombocytopenia, leading to the following symptoms:
5.Symptoms Due to High Numbers Of Leukaemia Cells
In acute myeloid leukaemia, the cancer cells are known as blast cells, which are like white blood cells, but larger in size. Consequently, they have difficulty passing through the narrow blood vessels. Therefore, if there is an increase in the number of leukaemia cells, it can block the blood vessels and hinder the passage of red blood cells as well, reducing oxygen transport to the rest of the body.
This condition is referred to as leukostasis. It is a rare condition, which requires medical emergency and quick treatment. Some of its symptoms include:
6. Symptoms Once Leukaemia Starts to Spread
Once cancer starts to spread to different parts of the body, it starts exhibiting the following symptoms:
Acute myeloid leukaemia is a result of changes in our DNA which causes normal bone marrow cells to transform into leukaemia cells. Although the exact cause behind AML is yet to be found, it is believed to be a result of a genetic mutation .
This mutation may abnormally accelerate the function of oncogenes (genes that help in the production, development and division of cells), and stop the function of tumour suppressor genes (genes that control cell division rate).
Some chromosomal mutations found in AML cases include:
In addition to these probable causes, there are certain risk factors that may increase the chances of acute myeloid leukaemia. They include the following :
Acute myeloid leukaemia types are categorised by two systems, namely:
However, the WHO system is most commonly used, which divides AML based on the type of myeloid cells and their causes, such as:
The AML types according to WHO include the following :
When the immature white cells (myeloblasts) accumulate outside of the bone marrow in acute myeloid leukaemia, it is known as granulocytic sarcoma. In addition, if you look at the tumour cells under a microscope, they might appear green. These can develop in any part of the body.
Another name for acute promyelocytic leukaemia is AML M3. It is a rare type of leukaemia and occurs when a kind of white blood cell called a promyelocyte fails to properly grow and develops cancer. Moreover, since it is an “acute” leukaemia, it develops swiftly and requires immediate medical attention .
In this type of leukaemia, AML and acute lymphoblastic leukaemia appear to coexist. The aberrant cells each have their specific proteins for ALL as well as AML markers. These are also referred to as acute bi-phenotypic leukaemia, which means having both kinds, and is incredibly rare.
Panmyelosis is a rare type of AML and is also hard to diagnose. It is also known as acute panmyelosis with myelofibrosis (APMF) or acute myelofibrosis. In this case, scar tissues replace the normal tissues in the bone marrow. This leads to panmyelosis, which prevents the bone marrow from producing enough platelets, white blood cells, or red blood cells.
Acute myeloid leukaemia is a type of cancer that progresses very quickly. Therefore, treatment must be started as soon as possible.
If you are diagnosed with AML, you must visit a certified oncologist immediately as the first part of the treatment, i.e. remission induction therapy must begin within 3 to 4 weeks from diagnosis . However, sometimes people who have a high number of myeloid cells, remission induction therapy may need more time to accelerate normal blood circulation. In such a case the doctors may need to start the treatment even earlier with leukapheresis .
An acute myeloid leukaemia diagnosis is crucial to determine the subtype of the condition, its progressing speed and appropriate treatment accordingly.
So, in order to diagnose which subtype of AML you may have, a series of diagnostic tests can take place. In addition, some of these may be repeated during and at the end of the treatments to understand their effects on the cancer.
Here is a list of important diagnostic tests your doctor may use for AML :
1. Blood Tests
In this test, a medical professional will collect a sample of your blood intravenously and send it for lab testing.
The lab will undertake the following tests:
2. Bone Marrow Tests
Bone marrow tests are carried out to examine the presence of leukaemia cells, and chromosomal or other cellular changes. The samples for these tests are generally taken in two methods:
These samples are then tested by a hematopathologist under a microscope to identify the presence of cancer cells or any sign of chromosomal changes that indicates AML.
In this test, leukaemia as well as lymphoma is diagnosed by comparing regular cells with cancer cells from the blood or bone marrow sample.
This test is carried out with the help of an instrument known as a flow cytometer, which measures the number of cells present in the sample. It also examines the special characteristics of these cells such as their shapes and sizes, if there are specific markers on the cell surface, etc.
For instance, the antigens present on the surface of leukaemia cells differ from those of normal ones and vary their subtypes as well. The most common type of antigens that identify leukaemia cells is called cluster of differentiation or CD.
Immunophenotyping is also used by doctors at the end of the cancer treatment to understand the minimal residual disease (MRD). This refers to the small number of cancer cells that may stay back after treatment.
Molecular tests analyse the genes and chromosomes present in the leukaemia cells of a patient. These include several tests such as:
There are a few tests that your doctor may perform before deciding on the treatment. These tests help to examine your overall health and any underlying disorder that may disrupt the leukaemia treatment. These tests include:
The prognosis of acute myeloid leukaemia depends on several factors, mainly your age, underlying medical condition, cause of the condition, risk level, and subtype .
Therefore, if you are in the low-risk group and have received the stem plant transplant treatment, you will have a 70-90% chance of long-time survival, i.e. beyond five years after remission. In cases of higher-risk patients, the prognosis is poorer. However, stem cell transplant may sometimes increase their chances.
In the type of AML which arises as a result of previous unrelated cancer treatment or has a secondary AML, the standard chemotherapy treatment becomes much harder. This leads to a poor prognosis.
Due to its aggressive nature, AML requires a team of multidisciplinary doctors for its treatment, which must ideally start within days after diagnosis.
Generally, the standard treatment for AML takes place in two phases :
Coming to the types, here are the most common treatment plans for AML:
1. Induction (Chemotherapy)
Chemotherapy is the initial treatment for AML and can either be intensive or non-intensive:
Here, a high dose of chemotherapy medicine is given to destroy the leukaemia cells from the bone and bone marrow. It mostly consists of a combination of two or more medications. This process includes blood transfusion as your body does not produce healthy blood cells due to cancer.
Chemotherapy is given in a healthcare centre or at home under the supervision of a nursing professional. It also comes with a number of side effects such as:
Intensive chemotherapy may become too stressful for some people, in which case doctors can suggest non-intensive chemotherapy. This therapy is done either orally, intravenously or through an injection under the skin.
In the case of acute promyelocytic leukaemia, other medicines are given alongside chemotherapy. The two most commonly used ones are:
Both of these medications help to convert immature white blood cells into mature healthy white blood cells.
This process generally comes after the induction of chemotherapy. The aim of consolidation is to prevent cancer from relapsing after ensuring that there are no more cancerous cells left after treatment.
In this process, you will receive regular injections containing chemotherapy medicines for several months depending on your case.
Radiotherapy is another effective treatment for leukaemia in which you will receive a high dose of controlled radiation to destroy the cancer cells.
Radiotherapy is also given as a preparation before a bone marrow transplant. Moreover, it is also used to treat critical cases, when cancer has spread to the brain or nervous system.
4.Bone Marrow and Stem Cell Transplantation
A stem cell transplant is a final treatment which is done in severe cases or when the chance of relapsing is high. Before the transplant takes place, patients are given intensive chemotherapy and radiotherapy to kill all the cancer cells from their bone marrow.
Next, they will receive new healthy stem cells through a tube inserted into the blood vessels, in the same manner as chemotherapy. The new step cells can either be donated from a healthy person or consist of your own. However, the donor and the recipient must have similar tissue types for this process.
Since the exact cause of acute myeloid leukaemia is yet to be known, it is difficult to state its preventive measures. Moreover, the major risk factors for this disease, such as age, gender or medical and treatment history are also beyond the control of the individuals .
Therefore, the controllable preventive measures include:
Acute myeloid leukaemia complications are:
The average cost of treating acute myeloid leukaemia in India is about Rs.10 Lakh or higher. The major treatment costs include induction chemotherapy. However, the costs may rise even higher in case a stem cell transplant is required.
Acute myeloid leukaemia is a type of blood cancer found commonly in adults and older people, but may also develop in children. In most cases, children with this disease are found to recover and lead a fully normal life. Recovery in adults may become more complicated, and the chances of relapse are often more frequent in older people. Nonetheless, with advanced cancer research and treatment, managing complicated cases has now become a little easier.
However, battling cancer is a costly affair. The multi-layered treatment, diagnosis and support will punch a deep hole in your pocket if you are unable to manage your finances well. Therefore, you need a solid health plan such as the Navi Health Insurance to take care of your medical expenses. Enjoy coverage up to Rs. 1 crore, 10,000+ network hospitals, annual check-ups and other perks for premiums starting just at Rs.234 per month. Get a quote now!
The survival of AML patients is generally 5 years after successful treatment. Consequently, the survival rate after treatment is about 27%. However, in the case of individuals under 45 years, the survival rate is about 69%.
There are different types of leukaemia, both chronic and acute. They include: Acute myeloid leukaemia (AML) Chronic myeloid leukaemia (CML) Acute lymphocytic leukaemia (ALL) Chronic lymphocytic leukaemia (CLL)
The most common challenges faced during the treatment of older patients include: Molecular abnormalities of the leukaemia cells are higher in older individuals They face more difficulty to undergo the intensive cancer treatments Comorbidities in older patients are higher due to diabetes, high blood pressure, heart diseases, cholesterol, stroke or other conditions.
Yes, treatments for AML can cause infertility, but in most cases, it is a temporary condition. Permanent infertility can occur in those individuals who go through an aggressive treatment procedure such as intensive chemotherapy, radiotherapy, or stem cell transplant.
The long-term effects of leukaemia treatment include the following: Infertility in both men and women Fatigue Heart issues Low resistance to infection Cognitive changes Osteoporosis Diabetes Second cancer, etc.
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