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What is AML?

Acute Myeloid Leukaemia, also known as Acute Myelogenous Leukaemia, is a type of Leukaemia that starts from young/ immature white blood cells called granulocytes or monocytes or myeloblasts in the bone marrow, where the new blood cells are made. AML causes the body to make too many myeloblasts which do not mature very quickly. These abnormal cells are not able to work properly. They build up in the blood and bone marrow and eventually spread very quickly to other parts of the body including the lymph nodes, spleen, liver, brain, spinal cord and testicles. In addition, they crowd out the normal residents of the bone marrow i.e. red cell precursors and platelet precursors. This build-up of immature white blood cells in the blood results in infections, feeling of tiredness & breathlessness due to anemia and easy bleeding. AML is more common in men than in women and it also affects children.

What Causes AML?

Doctors often don’t know why someone gets AML, but, they do know about some of the risk factors for the condition. The risk factor for AML Include:

  • Smoking
  • Exposure to certain chemicals such as benzene (a solvent used in oil refineries and other industries and present in cigarette smoke), certain cleaning products, detergents and paint strippers
  • Some chemotherapy drugs used to treat other cancers – especially when combined with radiation therapy
  • Exposure to high doses of radiation
  • Certain blood disorders such as myeloproliferative disorders (for example, chronic myelogenous leukaemia)
  • Some birth defects and disorders, such as Down Syndrome

Although there is no way to completely prevent AML, but the risk may be lowered by not smoking and avoiding exposure to chemicals.

What are the Symptoms of AML?

AML starts in the bone marrow – the spongy tissue inside bones where the blood cells are made. The disease prevents immature blood cells from growing into healthy blood cells – white blood cells (that help fight infections), red blood cells (that carry oxygen around the body) and platelets (that help the blood to clot).

In the early stages of AML, the body makes fewer healthy blood cells, and the symptoms seem like the symptoms of the flu – tiredness, fever, loss of appetite, weight loss and night sweats.

In fact, there are several forms of AML and each affects a different kind of blood cell. The symptoms depend on the type of blood cell that’s affected.

If there are fewer healthy red blood cells than normal, the symptoms include:

  • Tiredness
  • Weakness
  • Pale skin
  • Irregular heartbeat
  • Dizziness
  • Cold hands and feet
  • Shortness of breath
  • Headaches
  • Weight loss
  • Loss of appetite

If there are fewer healthy white blood cells than normal, the patient gets more infections than usual and may take a long time to get better. The infections can cause the following symptoms:

  • Fever
  • Weakness
  • Achy muscles
  • Fatigue
  • Diarrhoea
  • Sores that don’t heal

If there are fewer platelets than usual, the blood may not clot as well as it should. The symptoms include:

  • Easy bruising
  • Bleeding that can be hard to stop
  • Bleeding gums
  • Small red spots under the skin caused by bleeding
  • Nosebleeds

SYMPTOMS WHEN AML SPREADS: Leukaemia cells can spread to other parts of the body and cause the following symptoms:

  • Balance problems
  • Blurred vision
  • Bone or joint pain
  • Numbness in the face
  • Seizures
  • Spots or a rash on the skin
  • Swelling in the belly
  • Swollen, bleeding gums
  • Swollen glands in the neck, groin, underarms, or above the collarbone

Are there any more complications caused by AML?

Since AML affects the blood cells, it can lead to other problems like:

  • ANAEMIA – feel tired, weak, and short of breath as the body doesn’t have enough red blood cells that carry oxygen to all the organs and tissues.
  • BLEEDING – If AML affects platelets, the blood does not clot normally and the patient tends to bruise or bleed more easily than usual. The patient can also bleed inside the body, which could be serious.
  • WEAKENED IMMUNE SYSTEM – The white blood cells in the immune system normally find and attack invading germs. With AML, the body has fewer healthy white blood cells available to fight infections.

How is aml diagnosed?

If any of the above symptoms persist, one should immediately see the family doctor. The family doctor might then refer you to a Haematologist – a specialist blood doctor, who will do various tests to confirm the diagnosis of AML and of which type of AML.

PHYSICAL EXAMINATION: The doctor will do a physical examination to check the body for signs of cancer, such as bruises or spots of blood under the skin.

VARIOUS TESTS TO DIAGNOSE AML: Since AML affects immature blood cells called stem cells that grow into white blood cells, red blood cells, and platelets, the doctor will perform certain tests to look for immature or abnormal cells in the bone marrow:

  • BLOOD TESTS: The doctor will use different types of blood tests to diagnose AML –
    • Complete Blood Count (CBC) to check how many white blood cells, red blood cells and platelets are there in the blood. With AML, the patient may have more white blood cells and fewer red blood cells and platelets than normal.
    • Peripheral Blood Smear where a sample of the blood is examined under a microscope to check the number, shape, and size of white blood cells, and look for immature white blood cells called blasts.
  • BONE MARROW TESTS: To confirm the diagnosis of AML, the doctor would order a Bone Marrow Test – a Bone Marrow Aspiration and a Bone Marrow Biopsy. In this test, the Haematologist (a specialist blood doctor) will place a needle into a bone near the hip to remove a little bit of fluid or a small piece of the bone. This would then be sent to the lab to be examined under a microscope. If 20% or more of the blood cells in the bone marrow are immature, the haematologist will confirm the diagnosis of AML.
  • LUMBAR PUNCTURE: Also, known as a Spinal Tap, this test uses a needle to remove a small sample of cerebrospinal fluid (CSF), the fluid that surrounds the brain and the spinal cord. The CSF is examined under a microscope to see if it contains leukaemia cells.
  • IMAGING TESTS: These tests use radiation, sound waves, and magnets to make pictures inside the body. AML can form tumours that show up on scans, but the doctor might also use these tests to look for an infection or another problem AML can cause – CT Scan, Ultrasound, and X-Ray.
  • GENE TESTS: There are several forms of AML and the Haematologist can find out which one by looking for gene changes in sample of the blood or bone marrow. This will help the Haematologist find the treatment that is most likely to work on the cancer. These tests include:
    • Cytogenetic Analysis to look for chromosome changes in the cells. Sometimes in AML, two chromosomes switch DNA.
    • Immunophenotyoing Tests that look for substances called markers on the surface of leukaemia cells. Different types of AML cell have their own unique markers.
    • Fluorescent in Situ Hybridisation (FISH) to look for abnormal chromosomes in the cells using special dyes that attach to certain parts of the chromosome.
    • Polymerase Chain Reaction (PCR) that uses chemicals to find changes in genes.

How is AML Treated?

Three different treatments work on AML:

  • CHEMOTHERAPY
  • STEM CELL TRANSPLANT
  • RADIATION THERAPY

The treatment will have two phases:

PHASE 1: REMISSION INDUCTION THERAPY: The patient will get high doses of chemotherapy to destroy as many leukaemia cells as possible. The patient may need to stay in hospital for 3-5 weeks to monitor the condition and treat for any side effects of chemotherapy. After this treatment, the bone marrow should start to make healthy blood cells, and upon examination, if no leukaemia cells are visible, the patient needs to go through post-remission therapy.

PHASE 2: POST REMISSION THERAPY: It uses more treatments to wipe out any cancer cells that might have been left behind after chemotherapy. The therapy has three options:

  • Chemotherapy: The patient gets three to four cycles of high-dose chemotherapy once a month.
  • Allogenic (from a donor) stem cell transplant
  • Autologous (from yourself) stem cell transplant
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