Acute myeloid leukemia
What is that
The diagnosis
The stage of the disease
How to cure
Treatment based on the stadium
See also:
Chronic myelogenous leukemia
Chronic lymphatic leukemia
What is that
 |
| myeloid |
- white blood cells (or leucocytes): they help the body to fight infections;
- red blood cells (or erythrocytes): transport oxygen and other substances to all tissues;
- platelets: they are used for blood coagulation.
Acute myeloid leukemia in particular affects the immature cells called blasts that are about to give rise to granulocytes, a type of white blood cells. As a result, their numbers in the blood and bone marrow grow excessively.
The diagnosis
Diagnosis is often difficult to formulate. The initial signs may be similar to those of influenza or other common diseases. If fever, weakness or fatigue, pains in the bones or joints persist and do not regress, it is essential to go to the family doctor.
In the presence of these symptoms, the doctor, after the visit, prescribes blood tests, with particular reference to the complete blood count. If the analyzes are altered, it may propose further investigations, including bone marrow biopsy. This is done by inserting a needle into a bone (usually the pelvis), through which a fragment of marrow is taken to be analyzed under a microscope. This way you can determine the type of leukemia and plan the best treatment for your case.
The chances of recovery (prognosis) depend on the stage of the disease, as well as on the age and general health conditions.
Return to topThe stage of the disease
Knowing the stage of the disease is important for choosing the most appropriate treatment.
Regarding acute myeloid leukemia there is no standard staging system, and the choice of the most indicated therapy depends on whether the patient has already received treatment.
Untreated disease
The patient has just received the diagnosis of leukemia and the only treatment he received was aimed at resolving the symptoms (fever, pains in the bones or joints, etc.). The complete blood count is altered, the blasts represent at least 20% of the cells of the bone marrow and there could be other signs and symptoms typical of leukemia.
Disease in remission
The patient received treatment, the complete blood count is normal and the number of bone marrow-bone marrow cells is also back to normal. There are no signs or symptoms typical of leukemia.
Relapsing / refractory disease
Relapse means that the disease reoccurs after being in remission; leukemia is refractory when treatment does not follow a remission phase.
How to cure
The treatment of acute myeloid leukemia is divided into two phases:
remission induction therapy: aims to eliminate the largest possible number of blasts in the blood and bone marrow up to the remission of the disease;
post-remission therapy: once the disease is in remission, in the absence of signs of leukemia, it goes to the maintenance therapy phase, whose goal is to eliminate all the residual tumor cells. Chemotherapy can take several years to maintain the remission phase.
The therapeutic options currently available for the treatment of acute myeloid leukemia are:chemotherapy;
other drugs (trans-retinoic acid, arsenic trioxide) useful only in the case of a particular form of acute leukemia, that is to say the promyelocytic one;
radiotherapy;
bone marrow transplantation.
Chemotherapy is the therapeutic modality that destroys cancer cells through the administration of drugs, which can be taken by mouth in the form of tablets, or injected intravenously or intramuscularly. Chemotherapy is defined as systemic treatment, because the drug enters the bloodstream, spreads in the body and in this way can reach and destroy cancer cells in every part of the body. A particular mode of implementation of chemotherapy is represented by the administration by the intratecal way, in which the drug can be injected directly into the fluid surrounding the brain by inserting a fine needle into the spinal space, between the meninges and the spinal cord, at the level of the column lumbar.
Chemotherapy is the first choice treatment for the treatment of acute myeloid leukemia. There are various chemotherapeutic drugs potentially useful for the treatment of acute myeloid leukemia. These include, for example, cytarabine, daunorubicin, idarubicin, mitoxantrone, azacitidine, decitabine, clofarabine.
Radiation therapy can be used in some cases. Clinical trials are currently underway to assess the efficacy of bone marrow transplantation and biological therapy.
Radiotherapy consists of the application of high-frequency radiation to destroy neoplastic cells and reduce the size of the tumor. Radiation is usually provided by a special machine outside the body (external radiotherapy).
In the event that the leukemic cells have spread to the brain, the therapy may include cranial radiotherapy or intrathecal chemotherapy.
Bone marrow transplantation is intended to replace the diseased bone marrow with healthy bone marrow. The procedure begins with the administration of very high doses of chemotherapeutics, with or without radiotherapy, in order to eliminate the cancer cells and destroy the bone marrow. The healthy bone marrow is taken from a compatible donor and transferred to the recipient through a needle inserted into the vein, and in this way replaces the marrow destroyed by the chemo. The donor can be a twin, a brother / sister, a child, a parent or a non-consanguineous person. Transplantation performed with bone marrow taken from a donor is defined as allogeneic.
The efficacy of autologous transplantation is currently being evaluated, in which the bone marrow is taken from the patient himself, treated with drugs to eliminate all the tumor cells and frozen until the moment he is replanted in the patient. In the meantime, the patient undergoes high-dose chemotherapy, with or without radiation therapy, to destroy all the remaining bone marrow. At this point it is possible to proceed with the re-implantation of the preserved bone marrow (appropriately thawed) by inserting a needle into a vein.
A particular type of autologous transplant uses the patient's staminal-periphery cells. The blood is passed through a special machine that separates the stem cells. This procedure, which is called leukoferersis, lasts 3-4 hours. The peripheral stem cells thus obtained are then treated, stored and used as already described for bone marrow. Stem cell transplantation can be performed alone or in association with that of bone marrow.
The chances of success are greater if the procedure is implemented in a specialized hospital, where more than five bone marrow transplants are performed each year.
Treatment based on the stadium
The choice of therapy depends on the stage of the disease, the age and the general condition of the patient.
The oncologist may propose standard treatment for its proven efficacy, confirmed by previous experience, or participation in a clinical trial. Standard therapy does not necessarily work for all patients and sometimes involves more side effects than you think. For this reason, clinical trials are conducted in order to identify more effective treatment methods, based on the most up-to-date information currently available.Acute myeloid leukemia untreated
In this case the therapeutic option is remission induction therapy, which consists of systemic chemotherapy. Chemotherapy can be administered intrathecally if the tumor cells have reached the brain, or rather the central nervous system.
Acute myeloid leukemia in remission
Treatment of the disease in remission depends on a series of specific factors of the disease, on the type of response to induction therapy, on specific factors related to the patient (general health conditions, presence or absence of other diseases, age, etc.).
The therapeutic options are:
systemic chemotherapy;
allogeneic bone marrow transplantation
Acute relapsing / refractory myeloid leukemia
If complete remission (refractory disease) is not achieved, or if the disease recurs after obtaining remission (relapsing disease), the treatment options are:
systemic chemotherapy with drugs other than those used for previous therapy;
stem cell transplantation.
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