Contents
Acute myeloid leukemia (AML) requires very efficient diagnostic procedures – at the level of primary care physicians and hematologists. Each patient with suspected AML should immediately be referred to a specialist hematology center, where a quick diagnosis will be made and appropriate treatment implemented.
- Acute myeloid leukemia affects a relatively small number of people
- However, it is a very dangerous disease with high mortality
- An additional difficulty is the non-specificity of AML symptoms
- Only one of the six possible treatment options for the disease is available in Poland
- More current information can be found on the Onet homepage.
Department and Clinic of Hematology, Medical University of Lodz.
Acute myeloid leukemia (AML) is a very aggressive tumor of the haematopoietic system. If the disease is not recognized and treated promptly, it is fatal in a short time – within a few weeks to three months. AML is quite rare, with a frequency of about 4,1 per 100. inhabitants per year, but the incidence increases significantly with age. It comes from the very early, poorly differentiated cells of the myeloid line of the bone marrow, which multiply very quickly and displace normal cells of the hematopoietic system from the marrow. Leukemia cells can leak into the blood and can be found on a peripheral blood smear. In rare cases, leukemia cell infiltrates are present in other organs and tissues, most often in the skin, gums, and lymph nodes.
The deceptive non-specificity of symptoms
The clinical symptoms of AML arise from what is happening in the bone marrow. The displacement of normal hematopoietic cells leads to the visible deficiency of white blood cells – functional and healthy granulocytes in the peripheral blood; it also causes erythrocyte deficiency and various symptoms related to anemia, as well as a deficiency of platelets. The first symptoms are a non-specific mix. The following may occur: fatigue, decreased exercise tolerance, exacerbation of the symptoms of ischemic disease in the elderly, or the occurrence of heart failure for an unknown cause. The symptom is also frequent infections (which is associated with a deficiency of granulocytes), as well as hemorrhagic diathesis, i.e. a tendency to bruise and bleed – from the gums, initially when brushing the teeth, and then spontaneously. In extreme cases, life-threatening hemorrhages from the gastrointestinal tract or into the central nervous system may occur.
Symptoms of hemorrhagic diathesis are usually very worrying – both for the patient and the doctor, but when a patient with weakness, fatigue and infection comes to a primary care physician in the autumn-winter infectious period, it is not associated with acute myeloid leukemia in the first reflex. However, in a patient with cancer, symptoms worsen despite treatment for the infection, and he or she goes back to the doctor very quickly. At this point, a peripheral blood count must be performed at the health care practitioner level – this is a very good screening test for early suspicion of acute leukemia in the patient.
You can do a basic blood test without leaving your home. It is enough to order the service offered by the patient. You can find such a package in Medonet Market.
Treatment of AML is imperative
The goal is to completely cure the patient of leukemia, but the therapies used must be highly aggressive to be effective. In the first line, the standard is intensive chemotherapy, supported in selected cases by the transplantation of hematopoietic stem cells from a compatible family or unrelated donor.
The stage of intensive chemotherapy is induction treatment – it is supposed to destroy most of the cancer cells in the bone marrow and lead to complete remission of the disease, i.e. reduce the percentage of blasts to a level below 5%. This is a condition that moves on to the next stage of treatment. If treatment were discontinued in remission, the disease would come back after a few weeks as induction therapy does not destroy all the leukemia cells in the bone marrow.
To enhance the therapeutic effect and eliminate residual leukemia cells, post-remission treatment called consolidation is used. It is much more intensive than the induction treatment as it targets resistant tumor cells. Intensive chemotherapy and / or bone marrow transplantation are used here.
A boom in modern therapies – but not in Poland
The decision on the intensity of consolidation treatment has been made for many years on the basis of the cytogenetic test results. Currently, thanks to the development of modern technologies, also based on the result of molecular testing. Identification of various mutations within leukemia cells began, which not only improved the quality of diagnostic classifications, but some of these mutations became a potential therapeutic target. Therefore, the decision on how to treat a patient, which was once made only after remission of the disease and the application of universal induction treatment for all patients, has now moved to the beginning of the therapeutic process, i.e. immediately after the diagnosis of leukemia.
Not much has happened in the treatment of AML in the last 40 years, but thanks to modern diagnostic methods, there has been a huge breakthrough – we learned that acute myeloid leukemia is a highly heterogeneous disease – although it manifests itself in the same way, genetically it has several dozen different forms.
The last three years have also brought great progress in treatment. Currently, nine drugs are approved for the treatment of AML in the United States, seven in Europe, six of which are groundbreaking and should enter treatment. There is only one drug available in Poland. This means that in our country we only have a small part of the modern therapeutic options available – one of the six. It is only 16%, which is very little.
The article comes from the campaign “Hematology – learn about blood diseases” prepared by Warsaw Press, and the media partner of which is the medTvoiLokony portal. All materials can be found at http://www.warsawpress.com/
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