Acute Myeloid Leukemia (AML) Information, Diagnosis and Treatment

AML is one of the most common kinds of blood cancers, but still a rare disease and accounts for only one percent of all cancers. Only about 4.3 persons in every 100,000 will develop AML in their lifetimes.²

The exact cause of AML is unknown, but its development is a result of DNA changes in normal bone marrow cells. There are certain factors that predispose a person to developing AML. They include:

• Age: AML can develop at any age, but is uncommon in persons younger than 60
• Sex: AML is more common in men than women
• Family history: Having close relatives (a sibling or parent) with AML or other forms of leukemia increases the risk of developing AML. Having an identical twin with AML carries a significantly high risk.
• Genetic syndromes or inherited conditions: Having conditions or disorders like Down syndrome, Aplastic anemia, Fanconi anemia Kostmann syndrome and Li-Fraumeni syndrome increase the chances of developing AML.
• Medical history: A person has a higher risk of getting AML if one has a history of blood disorders like polycythemia vera, essential thrombocythemia and myelodysplastic syndrome exist.
• Smoking
• Exposure to radiation
• Exposure to benzene
• Having received chemotherapy treatment for a previous cancer³

The symptoms of AML are non-specific and are similar to those of many other conditions and diseases. They include:

• Fever
• Lethargy
• Fatigue
• Petechiae—small circular brown patches caused by bleeding under the skin
• Decreased appetite
• Bone and joint pain
• Easily bruised skin
• Frequent nosebleeds
• Bleeding of gums
• Pale skin⁴

In addition to a physical examination and medical history investigation, some tests that may be ordered to diagnose AML include:

• Complete blood count to check for the number of blood cells—red blood cells, white blood cells and platelets—in the body.
• Peripheral blood smear to check for the presence of blasts (immature cells) in the blood. Their presence in the blood is an indicator of AML, as they are usually confined to circulating in the bone marrow.
• Bone marrow aspiration and biopsies are done to obtain samples of the bone marrow for examination.
• Lumbar puncture to obtain cerebrospinal fluid. The fluid is checked for blood cancer cells and this is only done when it’s suspected that the cancer has spread to the brain and spinal cord.
• Chromosome tests like Polymerase Chain Reaction (PCR), Cytogenetics and Fluorescent in situ Hybridization (FISH) to check for chromosomal changes that are characteristic of AML.

Some of these diagnostic tests also help to classify AML and predict a patient's prognosis.^{5, 6}

AML can be treated successfully, especially if it's diagnosed early. Treatment takes place in two phases. The first, remission induction therapy, is targeted at destroying leukemia cells in the bone marrow and blood and putting the disease into remission. The second, post-remission therapy, is targeted at killing any remaining, inactive leukemia cells that have the potential to cause a future relapse.

Therapies used in both phases of treatment include:

• Chemotherapy
• Bone marrow transplant
• Targeted therapy drugs
• Radiation therapy⁷

The treatment approach used for children is usually moderately different from the approach taken with adults. This is because the genetic features of AML in children is significantly different from those of AML in adults. In fact, they are sometimes referred to as two distinct conditions.⁸