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.
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:
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:
The treatment of AML can be categorised into 2 phases:
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.
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).
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.
Specific tests are performed on the bone marrow aspirate including:
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.
At CFCH, we offer the following treatments for AML:
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:
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.
The information on the Centre For Clinical Haematology website is intended for educational use. It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.
We partner with major insurance providers in Singapore to streamline the financial process, allowing you to focus on what truly matters: your recovery. Contact our team for more information and support.
The CFCH team is committed to providing patient-centred care and comprehensive multidisciplinary support through every stage of your journey with us.
During your initial consultation, you'll meet our doctors who will listen to your concerns and begin your evaluation and recommend the necessary investigations required.
After diagnosis, we will plan your care, tailoring treatment options to your unique needs for the optimal outcome.
Throughout your treatment journey, we will provide a supportive environment to closely monitor your progress, ensuring your comfort and adjusting care as needed.
After treatment, we will continue to support you with a holistic approach to your recovery, to ensure that both your physical and mental wellbeing are looked after.
