Acute Myeloid Leukaemia: Symptoms, Causes and Treatment

Acute myeloid leukaemia is a rare cancer of the blood and bone marrow. Also known as acute myelogenous leukaemia, the disease includes the rapid growth of abnormal myeloid cells, which are a type of immature white blood cells. 

In healthy individuals, myeloid cells develop into various types of mature blood cells, like red blood cells, white blood cells, and platelets. However, in AML, the myeloid cells do not mature properly and accumulate in the bone marrow, disrupting the production of normal blood cells.

After understanding acute myeloid leukaemia definition, it is important to learn its type. Several subtypes of acute myeloid leukaemia are classified based on specific genetic and molecular abnormalities. These subtypes can influence the prognosis and treatment options for individuals with AML. Acute myeloid leukaemia classification is as follows:

1. Myeloid Leukaemia: Most people with AML have this subtype of acute myeloid leukaemia. Myeloid leukaemia is characterised by cancer in cells that produce neutrophils (a type of white blood cell that heals damaged tissue and resolves infections). 

2. Acute Monocytic Leukaemia (AML-M5): The subtype is characterised by cancer in cells that produce monocytes (white blood cell that fights viruses, bacteria, and other infections). 

3. Acute Promyelocytic Leukaemia (APL): This subtype of AML is cancer in promyelocytes (immature white blood cells) that restricts the development of these cells. 

4. Acute Megakaryocytic Leukaemia (AMLK): It is cancer in cells that produce red blood cells or platelets. 

Stages of Acute Myeloid Leukaemia

Acute Myeloid Leukemia (AML) is not typically staged in the same way as some other types of cancer, which are based on the size of tumours and their spread. Instead, acute myeloid leukaemia stages are based on overall blood cell counts and the presence of leukaemia cells in vital organs like the liver. 

Sometimes, the disease goes undetected unless it has spread to other organs. The staging of AML depends on the following:

1. How much cancer has spread.

2. The number of leukaemia cells in the body.

3. The number of healthy blood cells.

The nine acute myeloid leukaemia stages according to the French-American-British (FAB) classification are as follows:

1. M0: Undifferentiated AML (shows no markers specific to myeloid lineage)

2. M1: Myeloblastic leukaemia with minimal maturation (cells in the bone marrow show some signs of differentiation with minimal maturation)

3. M2: Myeloblastic leukaemia with maturation (cells in the bone marrow show different amounts of maturation)

4. M3: Promyelocytic leukaemia (immature white blood cells known as promyelocytes accumulate in the bone marrow)

5. M4: Myelomonocytic leukaemia (increased production of blast cells)

6. M4 eos: Myelomonocytic leukaemia with eosinophilia (increased production of blast cells and eosinophils, which are white blood cells that curb infection and boost inflammation)

7. M5: Monocytic leukaemia (cancer that affects the growth of monocytes)

8. M6: Erythroid leukaemia (leukaemia in the bone marrow due to abnormal blood-forming cells)

9. M7: Megakaryoblastic leukaemia (leukaemia that affects megakaryocytes, cells responsible for making platelets) 

These stages, which are also the subtypes of AML, affect cells in the bone marrow as follows:

1. Stages M0 to M5 begin in immature forms of white blood cells. 

2. Stage M6 starts in the immature form of red blood cells. 

3. Stage M7 starts in the immature form of cells that make platelets. 

In the early stages, acute myeloid leukaemia symptoms may begin with persistent cold or flu. Since AML is aggressive, patients can quickly develop new symptoms. General signs and symptoms of acute myeloid leukaemia in the later stages may include:

1. Fatigue and lethargy

2. Fever

3. Feeling cold

4. Bone pain

5. Night sweats

6. Appetite loss

7. Unexplained weight loss

8. Swollen lymph nodes

9. Pain in the back or abdomen

10. Fullness or swelling in the abdomen resulting from an enlarged spleen or liver

The shortages in red blood cells, white blood cells, and platelets may cause various symptoms. 

1. Acute myeloid leukaemia symptoms from low red blood cell count (anaemia) include:

   1. Fatigue
   2. Weakness
   3. Dyspnea (shortness of breath) during normal physical activities
   4. Dizziness, lightheadedness, or faintness
   5. HeadachesPale skin

2. Acute myeloid leukaemia symptoms from low white blood cell count (neutropenia) include:

   1. Frequent infections
   2. Infections that do not go away
   3. Fever

2. Acute myeloid leukaemia symptoms from low platelet count (thrombocytopenia) include:

   1. Bruising easily 
   2. Unusual bleeding, like frequent nosebleeds and bleeding gums
   3. Prolonged bleeding from minor cuts
   4. Persistent wounds or sores
   5. Petechiae (tiny red spots on the skin)

The exact acute myeloid leukaemia causes are not known. However, experts know that the condition occurs when a bone marrow cell develops mutations (changes) in its genetic material or DNA. A cell’s DNA contains instructions that inform the cell what to do. 

1. The bone marrow normally produces the exact number of blood cells and platelets the body needs to function. 

2. Normal cells follow genetic directions, such as when and how quickly to multiply and grow. As these cells age, they die and make space for new cells. 

3. However, in acute myeloid leukaemia, the bone marrow produces abnormal myeloid cells called myeloid blasts or myeloblasts, which do not act like normal blood cells.  

4. Myeloid cells don’t die and multiply uncontrollably, leaving less room for healthy blood cells. 

5. Furthermore, these cells can spill out of the bone marrow into the bloodstream, travelling to other body parts like the brain, central nervous system, and spinal cord. 

Acute Myeloid Leukaemia Risk Factors

Various risk factors can increase the chances of developing acute myeloid leukaemia. However, one must note that having a risk factor does not always mean that the person will get the disease. 

Sometimes, people may even get AML without having any known risk factors. These risk factors include:

1. Increasing Age: AML is more commonly diagnosed in older adults, with the risk increasing significantly after age 65. The incidence of AML rises steadily with age. However, it can also affect children. 

2. Gender: Males have a greater risk of developing AML than females. The reason for this is not clear. 

3. Cancer Treatment: Individuals who have undergone certain types of chemotherapy or radiation therapy for previous cancers have an increased risk of developing therapy-related AML. The risk increases with higher doses of chemotherapy or radiation.

4. High-Dose Radiation Exposure: High levels of radiation exposure, such as from nuclear reactor accidents or atomic bombs, have been linked to an increased risk of developing acute myeloid leukaemia. 

5. Long-Term Chemical Exposure: Prolonged exposure to high levels of chemical carcinogens like benzene and formaldehyde is associated with a greater risk of developing AML. Benzene is a chemical compound found in certain industrial settings, such as factories and chemical plants.

6. Smoking: Smoking tobacco can increase AML risk, particularly in individuals with a history of heavy smoking. It is the only proven lifestyle-related risk factor of acute myeloid leukaemia. 

7. Other Blood Disorders: Individuals with certain blood disorders have an increased risk of progressing to AML. The risk increases if these disorders are treated with chemotherapy or radiation. These blood disorders include:

1. Myelodysplasia (cancer in which immature blood cells do not become healthy blood cells)

2. Myelofibrosis (scar tissue forms in the bone marrow)

3. Polycythemia Vera (cancer in which the bone marrow makes too many red blood cells)

4. Thrombocythemia (bone marrow produces too many platelets)

8. Genetic Disorders: Rare inherited genetic disorders can increase the risk of developing AML. Some of these genetic disorders include 

1. Down syndrome (an extra copy of chromosome 21)

2. Bloom syndrome (a condition that causes changes in growth and facial features, frequent infections, and skin rash)

3. Fanconi anaemia (affects the bone marrow and several other body parts)

4. Li-Fraumeni syndrome (increases the risk of certain cancers)

9. Family History of AML: Although most AML cases do not have a strong genetic link, having a family member (a sibling or parent) with the disease can increase the risk. 

Genetic mutations cause acute myeloid leukaemia. However, what triggers these genetic mutations is not known. Therefore, AML cannot be prevented. But people can take some measures to reduce the risk of developing AML. These include:    

1. Quit Smoking: Smoking, including second-hand smoke, is the most controllable risk factor for acute myeloid leukaemia. Thus, one should quit smoking or reduce spending time with the person who smokes.

2. Limit Alcohol Consumption: Excessive alcohol consumption has been associated with an increased risk of developing AML. Reducing alcohol intake can significantly lower the risk of not only AML but also other types of cancers and various health conditions.

3. Avoid Exposure to Cancer-Causing Chemicals: People who work around carcinogenic chemicals like benzene and formaldehyde should follow safety precautions, like wearing protective clothing. 

4. Maintain a Healthy Lifestyle: A healthy lifestyle can contribute to overall well-being and reduce the risk of various cancers, including AML. This includes adopting a balanced diet rich in fruits, vegetables, whole grains, and lean proteins, engaging in regular physical activity, and maintaining a healthy body weight. 

5. Minimise Exposure to Radiation: High-dose radiation exposure, such as that received during certain cancer treatments or nuclear accidents, can increase the risk of developing AML. Discuss the potential risks and benefits with your healthcare provider if you need radiation therapy for a medical condition.

Certain acute myeloid leukaemia symptoms may suggest a person has the disease, but tests are needed to confirm the diagnosis. 

Generally, for an individual to be diagnosed with AML, 20% or more cells in the bone marrow or blood must be myeloblasts. An accurate diagnosis helps doctors to:

1. Estimate the progression of the disease

2. Determine the appropriate treatment approach 

The key components of the diagnostic process for AML include:

1. Medical History and Physical Exam: The healthcare professional will evaluate the individual’s medical history, including symptoms, previous medical conditions, and any known risk factors for AML. 

   1. A physical examination will assess general health and look for signs or symptoms of leukaemia, like enlarged lymph nodes or an enlarged spleen.
      
      
   2. They may also check for bruises, bleeding, or infection.
      
      
   3. The person may be referred to a haemotologist (a doctor specialising in blood diseases). 

2. Blood Tests: The patient’s blood samples will be collected to assess the complete blood count (CBC) and peripheral blood smear. 

1. The CBC measures the levels of different blood cells, such as white blood cells, red blood cells, and platelets. 

2. Individuals with AML often have abnormal blood cell counts, including low red blood cell and platelet counts and abnormal white blood cell counts.

3. The peripheral blood smear examines the number, size, and shape of these blood cells to determine if leukaemia cells are present in the blood.

3. Imaging Tests: Imaging tests like X-rays, MRI, CT scans, and ultrasounds are not often used to diagnose leukaemia, but they help look for infections and other problems. By offering a clear picture of the inside of the body, these tests help show the spread of cancer to other body parts. 

4. Bone Marrow Samples: Blood tests can suggest leukaemia, but doctors usually require bone marrow samples to confirm the diagnosis. Bone marrow samples are obtained from the hip bone under two tests generally performed at the same time:

1. Bone marrow aspiration (to remove a sample of liquid bone marrow)

2. Bone marrow biopsy (to remove a sample of bone filled with marrow)

3. Both samples are sent to a laboratory to be examined under a microscope and look for cell changes. 

5. Lumbar Puncture (Spinal Tap): In some cases, a spinal tap may be done to assess the cerebrospinal fluid for the presence of leukaemia cells. The doctor collects the fluid by inserting a small needle into the spinal canal of the patient’s lower back. 

6. Biomarker Testing of Leukaemia Cells: The doctor may recommend doing genetic tests to identify certain genes and proteins involved in leukaemia. It also helps identify the acute myeloid leukaemia type and choose treatment options. Genetic tests used to diagnose AML include: 

   1. Immunohistochemistry: The test uses a special dye to learn more about leukaemia cells and determine the exact subtype of AML. This dye stains cells differently based on the cell’s chemicals. These staining cells are then viewed under a microscope. 
      
      
   2. Flow Cytometry (Immunophenotyping): The test is used to measure different characteristics of cancer cells. Acute myeloid leukaemia cells have distinctive markers known as surface markers. Flow cytometry identifies these markers, distinguishing AML cells from healthy blood cells and other forms of leukaemia. 
      
      
   3. Karyotyping (Cytogenetic Analysis): People typically have 23 pairs of chromosomes. Sometimes, people with cancer may have certain changes to their chromosomes. A karyotype test examines blood or bodily fluids to detect abnormal chromosomes.  
      
      
   4. Fluorescence In-Situ Hybridisation (FISH): The test uses the tissue removed during a biopsy or aspiration to detect chromosome changes in cancer cells.  

How to Prepare for Doctor’s Consultation?

Preparing for a doctor’s consultation for acute myeloid leukaemia can help ensure the patient makes the most of their time with the healthcare provider and gather the necessary information. Here are some steps to help them prepare:

1. Take a Prior Appointment: The patient should make a prior appointment and learn any pre-appointment restrictions, such as a restricted diet. 

2. Write Down Symptoms: The patient should note any specific symptoms they have been experiencing related to AML. This can help the doctor better understand their situation and address their needs.

3. Give a Medical History: The patient should provide a detailed medical history, including past medical conditions, surgeries, treatments, and medications.

4. Write Down Questions: Preparing a list of questions for the doctor to ask during the consultation is recommended. This can help ensure that all the queries are addressed and nothing is overlooked.

5. Bring a Friend or Family Member Along: Patients must consider bringing a family member or friend to the consultation for emotional support and to help take notes. They can also provide an additional perspective and remember details.

What to Expect from the Doctor?

During a consultation appointment for acute myeloid leukaemia, the doctor may ask the patient various questions to gather information about their condition. Some potential questions the doctor may ask include:

1. When did you first notice symptoms or signs of illness?

2. Have you had any recent bleeding or bruising episodes?

3. Have you had any recent infections or experienced frequent infections in the past?

4. Have the symptoms been continuous or occasional?

5. How severe are your symptoms?

6. Does anything improve or worsen your symptoms?

7. Have you undergone any treatments for AML or other cancers in the past?

8. Have you been exposed to radiation or certain chemicals in your workplace or environment?

What to Ask the Doctor?

When consulting a doctor about acute myeloid leukaemia, the following are some questions the patient may consider asking:

1. What is likely causing my symptoms?

2. What kind of tests do I need?

3. What type of AML do I have?

4. What treatment options are available for my specific AML type?

5. Can you please explain the risks and benefits of each treatment option?

6. What is the goal of the treatment plan?

7. How will treatment affect my daily life and routine?

8. How can I manage treatment side effects?

9. What follow-up care will I need after treatment?

10. Are there any restrictions to be followed?

11. What signs of complications should I look out for?

12. What factors might affect my prognosis?

13. Am I eligible for any AML clinical trials or experimental treatments?

14. Are any resources or support groups available for AML patients and their families?

Since this cancer grows quickly, it is important to begin prompt acute myeloid leukaemia treatment. The factors that influence the type of treatment modality include:

1. The AML subtype

2. The results of cytogenetic analysis

3. Whether the AML is in the central nervous system

4. Whether cancer has not responded to treatment or relapsed

5. Whether the patient has had myelodysplastic syndrome (MDS) or other blood cancer

6. Whether the patient has received chemotherapy in the past to treat a previous cancer

7. The patient’s age and general health

8. The patient’s preferences

In general, the treatment for AML is divided into two phases:

1. Remission Induction Therapy: The first treatment phase is called induction therapy. 

1. This phase aims to induce remission by eliminating as many leukaemia cells as possible. 

2. However, this phase usually does not wipe out all the leukaemia cells. Therefore, the patient requires further treatment to prevent the disease from returning. 

2. Consolidation Therapy: After achieving remission with induction therapy, the second phase of treatment begins. 

1. Also known as maintenance or post-remission therapy, consolidation therapy aims to eliminate any remaining leukaemia cells. 

2. This phase helps to prevent relapse and improve long-term outcomes.

Acute myeloid leukaemia treatment used in these phases includes:

1. Chemotherapy: Chemotherapy is a vital component of the treatment approach for AML. 

1. It involves using powerful drugs (Venetoclax, Cytarabine, Azacitidine) to kill leukaemia cells and achieve remission. 

2. While it is majorly used for remission induction therapy, it can also be used for consolidation therapy. 

3. Patients may receive high-dose cytarabine (Ara-C) or HiDAC for five days each month for consolidation and maintenance therapy. The treatment may continue for 3 to 4 months to kill any remaining cancerous cells and lower the risk of cancer recurrence. 

2. Targeted Therapy: Targeted therapy is an innovative approach to treating AML, focusing on specific genetic mutations or abnormal proteins in leukaemia cells. 

1. Unlike traditional chemotherapy, targeted therapies are designed to selectively attack cancer cells while sparing healthy cells, potentially leading to more effective and less toxic treatments. 

2. Targeted therapy may treat AML that has returned or not responded to chemotherapy. 

3. Bone Marrow Transplant: A healthcare professional may recommend a bone marrow transplant or a stem cell transplant for AML patients in remission and who can tolerate intensive chemotherapy. 

1. The procedure may be used during consolidation therapy. It involves replacing diseased or damaged bone marrow with healthy stem cells to regenerate healthy bone marrow.

2. Before a bone marrow transplant, the patient receives high-dose chemo or radiation therapy to kill the remaining leukaemia cells in the body. Then, they receive an infusion of stem cells from a compatible donor (allogeneic stem cell transplantation). 

3. The patient can also receive their own stem cells (autologous stem cell transplantation) if they were previously in remission and had stem cells collected and stored before chemotherapy. 

4. Clinical Trials: Some people with AML may enrol in clinical trials to try experimental treatments. It can be the best treatment choice for some patients. 

Cost of Acute Myeloid Leukaemia Treatment

The cost of acute myeloid leukaemia treatment depends on several factors, including the stage of the cancer, the treatment approach, the patient’s age, the patient’s comorbidities, location and type of hospital, doctor’s expertise, insurance coverage and much more.

To know the exact cost of acute myeloid treatment, one should consult their doctor. The below table also provides the approximate cost of various treatment modalities for acute myeloid leukaemia.

Survival Rate for Acute Myeloid Leukaemia

The five-year survival rate for people with AML is 31.7%. The survival rate decreases as the patient’s age increases. 

According to this acute myeloid leukaemia life expectancy statistics, less than 1 in 3 people who receive a diagnosis for AML will survive for more than five years after diagnosis. The acute myeloid leukaemia survival rate depends on several factors, including: 

1. The patient’s age

2. The stage of AML

3. The presence of genetic or chromosomal risk factors

The acute myeloid leukaemia death rate is 2.7 per 100,000 men and women. Approximately 11,400 deaths occur every year due to AML. 

Acute Myeloid Leukaemia Prognosis

Younger patients with AML generally have a better prognosis than older patients. When a bone marrow biopsy shows no signs of acute myeloid leukaemia, the person is said to be in remission. 

1. An estimated 50% to 80% of people achieve complete remission after AML treatment. It occurs more in children and people under the age of 60. 

2. About 50% of people in complete remission may develop recurrent AML. In such situations, doctors may suggest additional chemotherapy, stem cell transplantation, or participation in clinical trials.

If a person has acute myeloid leukaemia, they may experience several complications. These complications may be caused due to the impact of cancer on the body but may also develop as a treatment side effect. These complications include:

1. Weakened Immune System: One common complication of AML is having a weakened immune system. 

1. AML weakens the immune system, making patients more susceptible to infections. Infections can be severe and life-threatening. If treated early, almost all infections respond well to treatment. 

2. Bleeding: AML affects the normal production of platelets responsible for clotting blood. As a result, patients may experience increased bleeding and bruising. 

1. Patients with final stages of acute myeloid leukaemia are more prone to excessive bleeding inside their body, such as the skull, lungs, and stomach. 

3. Anaemia: AML can cause a decrease in healthy red blood cells, leading to anaemia. Anaemia can result in fatigue, weakness, and shortness of breath. 

4. Organ Damage: AML can infiltrate and affect various organs, leading to organ damage. 

1. This can result in complications such as liver dysfunction, kidney problems, lung issues, and heart abnormalities. 

2. Organ damage can further worsen the overall health condition and require additional medical interventions.

5. Treatment-Related Complications: The treatments used for AML, such as chemotherapy, radiation therapy, and stem cell transplantation, can carry their own risks and complications. 

1. These may include side effects like nausea, vomiting, hair loss, increased susceptibility to infections, and potential long-term effects on fertility or organ function.

When to Consult a Doctor?

Patients should visit their healthcare professional if they experience acute myeloid leukaemia symptoms. They should also visit their doctor through remission or when they experience symptoms that indicate that AML has relapsed. These symptoms include:

1. Tiredness

2. Bruises

3. Swollen glands

4. Fever

5. Sweating

6. Shortness of breath

7. Headaches

8. Bone pain

Cancer and cancer treatments usually affect a person’s desire and ability to eat. But good nutrition is important as it ensures that patients get the nutrients their bodies need. While no specific diet can cure AML, a nutritious diet can help:

1. Maintain strength and energy

2. Reduce unintentional weight loss

3. Support immune system

4. Improve tolerance to certain treatments

5. Improve healing and recovery time

Foods to Eat

Individuals should make sure to eat foods high in protein, healthy fats, and carbohydrates to get enough calories to maintain their weight. 

1. Protein-rich foods include meat, fish, beans, lentils, cheese, eggs, milk, yoghurt, etc. 

2. Healthy fats-rich foods include olives, nuts, avocados, seeds, oils, etc. 

3. Carbohydrates-rich foods include rice, bread, oatmeal, corn, barley, cereals, pasta, potatoes, etc.  

If people are unable to eat enough food, they must eat high-calorie food like:

1. Smoothies

2. Ice cream

3. Gravy

4. Creamy soups

5. Nutritional supplements

Additionally, it is important to stay well-hydrated by drinking plenty of fluids, especially water. Proper hydration can help manage treatment side effects like constipation, dry mouth, and nausea.

Foods to Avoid 

There are no “off-limit” foods for AML. However, it is best to limit food and beverages with high salt, fat, and sugar. Foods that can cause foodborne illnesses and, therefore, must be avoided include:

1. Uncooked or undercooked meats, fish, poultry, and eggs

2. Raw bean sprouts

3. Unwashed fruits and vegetables

4. Improperly canned fruits

5. Unpasteurised milk, juices, and cheese

6. Certain soft cheeses

7. Expired food

Acute myeloid leukaemia is a complex and aggressive form of leukaemia that affects the blood and bone marrow. It requires prompt diagnosis and appropriate treatment to improve outcomes. Advances in targeted therapies and immunotherapies offer new hope for patients, and ongoing research continues to expand our understanding of the disease.

HexaHealth, a comprehensive healthcare platform, can help support individuals with AML. Our team of professionals helps streamline medical records, facilitates communication between patients and healthcare providers, and offers personalised support for managing symptoms and treatment side effects.

Moreover, we provide educational resources and information about acute myeloid leukaemia pathology outlines. Contact us TODAY to enhance your care experience and improve your treatment outcomes for AML.

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