Table of Contents
What is Acute Myeloid Leukaemia (AML)?
Acute Myeloid Leukaemia (AML) is a type of blood cancer that occurs due to the excessive production of a specific type of immature white blood cells (also known as myeloblasts) in the bone marrow. These excess myeloblasts cause overcrowding in the bone marrow, leaving little room for the production of other healthy blood cells such as red blood cells and platelets..
Causes of Acute Myeloid Leukaemia (AML)
Acute Myeloid Leukaemia may occur due to the damage to the DNA of cells in the bone marrow. This can affect the production of blood cells in the bone marrow resulting in the production of immature white cells called myeloblasts..
While the exact causes for the DNA mutations to the bone marrow cells are not known, factors that affect the incidence of AML include:
- Age: The risk of AML increases with advancing age. It has been found that Acute Myeloid Leukaemia is more common in adults above the age of 65 years old.
- Gender: The incidence of Acute Myeloid Leukaemia is higher in men than in women.
- Exposure to cancer treatment: Patients who have received chemotherapy or radiation for the management of cancer are more prone to developing AML.
- Exposure to radiation: It has been found that exposure to high levels of radiation may lead to abnormal changes in the bone marrow and trigger the development of AML. Survivors of nuclear reactor accidents may be at risk of developing AML.
- Pre-existing blood disorders: Patients who suffer from other blood disorders such as myelofibrosis, myelodysplasia, thrombocythaemia, or polycythemia vera could be at risk of developing AML.
- Exposure to certain chemicals. Some chemicals such as Benzene can increase the chances of developing AML. However strict regulations in most countries limit the exposure of such chemicals which means they play a very small part in causing AML.
- Smoking: Smoking is associated with more than 15 types of cancers including leukaemia, as cigarettes contain many substances which are harmful to the body. There are also reports on an increased risk of leukaemia in children of parents who smoke.
- Genetic disorders: The risk of AML is more in patients with genetic diseases such as Down syndrome.
Signs & Symptoms of Acute Myeloid Leukaemia (AML)
The symptoms of Acute Myeloid Leukaemia may vary depending on the type of blood cells affected. However, in the initial phase, the symptoms may be similar to that of the flu..
As the disease progresses, patients may develop symptoms such as:
- Repeated infections
- Pale skin
- Difficulty in breathing
- Pain in the bones
- Tendency for bruising and unusual bleeding
- Bleeding from the nose or gums.
Treatments for Acute Myeloid Leukaemia (AML)
The treatment of AML can be categorised into 2 phases:
- Induction therapy: This is the first phase of AML treatment. It is aimed at destroying leukaemia cells in the bone marrow and blood. However, remission induction may not kill all the leukaemia cells. Hence, further treatment is needed to prevent relapse.
- Consolidation therapy: This phase of AML treatment involves the destruction of the remaining leukaemia cells. It is also called maintenance therapy or post-remission therapy. It is considered vital for reducing the risk of relapse.
Depending on the patient’s age, health condition and subtype of cancer, AML treatment may include one or a combination of the therapies discussed below:
Chemotherapy is a form of induction therapy although it is sometimes included in the consolidation therapy as well. Chemotherapy involves the use of medications to kill cancer cells. The number of sessions of chemotherapy depends on the extent of AML..
Targeted therapy involves the use of drugs such as Midostaurin that directly attack specific vulnerabilities of cancer cells. Midostaurin works by inhibiting the action of an enzyme in the cancer cells (known as the FLT3-ITD mutation) thereby preventing their survival..
Other drug therapy
Anti-cancer drugs such as all-trans retinoic acid (ATRA) and Arsenic trioxide (Trisenox) can be included in the treatment of a subtype of Acute Myeloid Leukaemia, known as Acute Promyelocytic Leukaemia (APML)..
Stem Cell transplantation
Not all patients with AML require a stem cell transplantation. However patients with poor risk AML, or those who have not responded well to induction or consolidation chemotherapy will often need to proceed to transplantation if a suitable donor can be identified.
A bone marrow transplant is often included in the consolidation phase. A bone marrow transplant is aimed at re-establishing healthy stem cells in the marrow. It involves replacing unhealthy marrow with healthy stem cells to stimulate the regeneration of mature blood cells.
High doses of chemotherapy or radiation is given before a bone marrow transplant to destroy abnormal marrow. This is followed by the infusion of healthy stem cells from a compatible donor.
FAQs on AML
- Blood tests
The presence of too many white cells with a reduced count of red cells and platelets in the blood could be a sign of AML. The presence of immature blast cells, which are normally present in the bone marrow but not in the peripheral blood, can also be considered an indicator of AML.
- Bone marrow biopsy
A bone marrow biopsy and aspiration involve the insertion of a thin needle into a long bone of the body to withdraw a small amount of marrow. The sample can be tested in a laboratory to detect any abnormalities linked to AML.
Specific tests are performed on the bone marrow aspirate including:
Immunophenotyping is a specialist test that is performed on either a blood sample or bone marrow aspirate sample. The patient sample is analysed through a machine known as a flow cytometer, which allows identification of abnormal markers which are present on the surface of white cells.
Immunophenotyping allows for the detection of blood cancers, and aids in the classification of the sub-type of the blood cancers. In addition, as the test can detect even small amounts of residual disease in the blood or bone marrow, it is used following treatment to assess disease response.
- Cytogenetic tests
Genetic tests of the bone marrow can help to confirm the diagnosis of AML. The results of these studies can also be useful for determining how the disease will progress in the future.
This test involves the examination of the chromosomes in the cells of the marrow sample taken during a biopsy. It can help to detect mutations in the chromosomes that can affect the functions of the bone marrow and trigger the development of AML.
- Molecular testing
Increasingly, there are several recognised molecular genetic abnormalities (mutations) in AML cells that are linked to prognosis. Molecular testing provides information on the risk group of AML patients. In addition, monitoring of the level of known mutations in patients often also allows us to measure the response of patients to therapy, even when there may be only very small levels of AML disease in the bone marrow.
The majority of Acute Myeloid Leukaemia cases are idiopathic in nature, as in, there is no identifiable cause. As such, there are no known ways to prevent the majority of AML.
Some patients develop AML after prior treatment with chemotherapy or radiotherapy for another primary cancer (AML occurring in this situation is known as secondary AML). Rarely AML may also occur in patients who had prior occupational exposure to certain cancer-causing agents (carcinogens) or in patients who have had accidental exposure to high doses of radiation.
Smoking is one of the controllable risk factors of Acute Myeloid Leukaemia, although the impact of smoking on AML is not high. However, quitting smoking will help reduce a person’s risk of developing AML.
AML and the treatment related to AML will cause your immunity to weaken. As such, you will need to focus on your general well-being and diet.
Make sure you are well-rested but also maintain an active lifestyle as far as possible. Walks or simple exercise are encouraged. It is important that your family (or even close friends) are involved in supporting you, as the battle against AML is often stressful and tiring. It is important to have your family and friends available to support you on your treatment journey.
Our team of doctors and nurses at CFCH will advise you along every step of your AML treatment plan. In addition, we may recommend psychologists or dieticians to work with you as we develop a holistic treatment plan to provide you with the best support.
A well-balanced diet can aid patients in coping with AML and its treatment. Patients may find that they are losing weight due to a loss of appetite as a side effect of some treatment options. Our doctors and nurses, together with dieticians, will offer you support on your diet. Some patients may be offered high-calorie, high-protein drinks to help regain their energy.
The symptoms of Acute Myeloid Leukaemia (AML) often develop over a few weeks to a few months before patients actually become symptomatic. Once patients are symptomatic with abnormalities in their blood counts, then treatment for AML is often a medical emergency with urgent stabilisation required.
Unlike Acute Myeloid Leukaemia (ALL), which often may involve the brain and the central nervous system, Acute Myeloid Leukaemia (AML) rarely affects the brain or the spine or central nervous system.
AML is a fast-progressing and aggressive form of cancer. Unlike most cancers that affect solid organs, AML is a liquid cancer of the white blood cells. As such, often the only organ involved in the blood system itself.
AML cells can occasionally spread to other organs and parts of the body. For example, Acute Myeloid Leukaemia may spread to the testicles, spleen, spinal cord, brain, liver, and lymph nodes.
Leukaemia is a cancer that begins in the blood-forming cells of one’s bone marrow. Depending on whether the abnormal cells are mature or immature, you have either acute or chronic leukaemia.
The primary difference between Acute Myeloid Leukaemia and Chronic Myeloid Leukaemia is that the onset of AML is fast and aggressive, while CML generally progresses more slowly. Unlike AML, the majority of CML cases can be successfully managed with targeted oral therapy.
The primary difference between Acute Myeloid Leukaemia (AML) and Chronic Myeloid Leukaemia (CML) is that the onset of AML affects immature stem cells in the bone marrow and is a fast and aggressive form of blood disorder. On the other hand, CML affects the more mature forms of white cells in the bone marrow and tends to progress more slowly.
Most forms of CML are of an early stage (CML chronic phase) and can be very effectively treated with oral targeted therapies. However, in some cases, Chronic Myeloid Leukaemia develops into a more advanced stage, and occasionally CML can transform into Acute Myeloid Leukaemia. This form of CML, known as blast-phase CML, occurs less commonly since the start of the targeted era of drug therapies for CML.
Acute Myeloid Leukaemia is an aggressive form of cancer and requires immediate treatment. Unfortunately, without proper treatment, patients may be given a prognosis of less than 6 months, with a major cause of death being related to infections or bleeding.
FAQs on AML Treatments
At CFCH, we offer the following treatments for AML:
- Targeted therapy
- Stem cell transplant
- Other drug therapies
Unfortunately, even with chemotherapy and the latest available novel therapies, only a portion of AML patients can be successfully cleared of their disease.
Even with newer, targeted novel therapies, the vast majority of leukaemia cases require a combination of novel agents with conventional chemotherapy and sometimes even a bone marrow transplantation for successful clearance of the AML.
For patients who need intensive chemotherapy for treatment of their Acute Myeloid Leukaemia, they will typically receive 4-5 cycles of intensive therapy. Each session of chemotherapy may last for 4 weeks.
Patients who are receiving intensive chemotherapy followed by transplantation typically receive 2-3 cycles of chemotherapy before undergoing the bone marrow transplantation.
Patients who are not fit for intensive chemotherapy or transplantation may receive continuous cycles of non-intensive targeted therapy.
The specific treatment protocols for each AML patient often varies based on individual factors, and our doctors at CFCH will discuss your personal AML treatment plan in detail with you.
Midostaurin is a drug that can directly attack specific vulnerabilities of cancer cells and prevent their survival.
Acute Myeloid Leukaemia is usually a liquid cancer, only involving the blood system and bone marrow.
However, Acute Myeloid Leukaemia can sometimes present with solid tumours known as a myeloid sarcoma or chloroma. These tumours can develop anywhere in the body. It is often referred to as extramedullary disease. Patients with these solid tumour forms of AML often have a more aggressive form of leukaemia.
A bone marrow transplantation remains the only potential curative procedure for many forms of Advanced Acute Leukaemia. However, the cure rate varies depending on the disease stage of the leukaemia. Our transplant team at CFCH will take the time to explain the treatment plan and chances of response to your therapy.
Anti-cancer drugs like all-trans retinoic acid and Arsenic trioxide can be used to treat an AML subtype called Acute Promyelocytic Leukaemia (APML).
AML patients most usually need transfusions at the beginning of their treatment when the AML has been diagnosed. This is when the burden of leukaemia cells is the largest in the bone marrow, and the normal production of red cells in the bone marrow is suppressed.
Patients may also need further transfusions during ongoing treatment, or during their bone marrow transplantation. Unfortunately, in cases where the AML is not controlled well or where the AML has recurred, patients may become more dependant on blood transfusions.
Depending on the patient’s status, patients may need blood transfusions weekly in severe cases.
Intensive chemotherapy remains the treatment of choice for younger and fitter AML patients. Some of these patients may also need an allogeneic haematopoietic stem cell transplantation. As such, the treatment for AML may last for up to 6 months.
In older patients or patients who are not fit for intensive chemotherapy or transplantation, treatment is often less intensive. However, in these cases, while the treatment is usually better tolerated, the duration of treatment is often continuous, with the aim to control the patient’s disease.
The cost of AML treatment varies depending on several factors, including:
- The treatment drugs needed (non-intensive vs intensive chemotherapy vs targeted therapy)
- Presence of pre-existing complications, such as active infection.
- Whether the patient requires a bone marrow transplantation.
- Whether the patient requires in-patient or out-patient therapy.
Our doctors at CFCH will assess your medical condition and advise you on the best treatment plan going forward. Based on this, you will be provided with a detailed breakdown of the cost estimates for your therapy.
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© Centre for Clinical Haematology | 2023
Monday to Friday : 8.30am – 5.30pm
Saturday : 8.30am – 12.30pm
Closed on Sunday & Public Holidays
Find us on Facebook
Drop a Line
© Centre for Clinical Haematology | 2023