Acute Myeloid Leukemia (AML): Information on Causes, Diagnosis & Treatments
Acute myeloid leukemia (AML) is a devastating cancer that affects blood and bone marrow that is most commonly found in adults suffering from the condition. Doctors also refer to this form of the disease as acute non-lymphocytic, acute granulocytic leukemia, and acute myelogenous leukemia. Acute means that the leukemia cancer develops quickly. Myeloid refers to the type of cell that it affects. Myeloid cells are precursors (immature) blood cells that can mature into some forms of white blood cells, red blood cells, and platelets. However, acute myeloid leukemia prevents the cells from developing normally.
The cancer prevents the normal function of red blood cells, white blood cells, and blood platelets and prevents them from reproducing newly formed healthy cells. Eventually, the affected body tissue and organs begin reacting to the lack of necessary red blood cells, which carry oxygen, white blood cells that support the body's immune system, and platelets used in blood coagulation during bleeding, that can produce a deadly combination.
Fortunately, acute myeloid leukemia is a treatable cancer. Recent advancements in medical research have led to a better understanding of the disease and how to treat the condition to ensure patient can survive the devastating disease.
- Who Gets Acute Myeloid Leukemia?
- Common Symptoms
- Diagnosing Acute Myeloid Leukemia
- Treating the Condition
Who Gets Acute Myeloid Leukemia?
There are many known risk factors associated with acute myeloid leukemia. However, simply having one of the risks does not definitively mean the individual well acquire the disease. The most common known risk factors associated with AML include:
- Smoking – Lifestyle choices including smoking are known to affect the lungs, throat, mouth and voice box (larynx). This is because tobacco smoke releases cancer-causing substances into the mouth and throat that will be absorbed by the lungs and eventually spread to the body's bloodstream to distant sites.
- Chemical Exposure – Bodies that are exposed to elevated levels of benzene – a toxic chemical used in work environments, living environments, and in some consumer products – are more susceptible to developing acute myeloid leukemia. This includes individuals who work close to or use products in chemical plants, oil refineries, rubber industries, gasoline -related industries, shoe manufacturing companies and others. These include those around motor vehicle exhaust, gasoline exhaust, cigarette smoke, cleaning products, art supplies, detergents, and paints.
- Chemotherapy Medications – Some chemicals used in chemotherapy medications are known to cause acute myeloid leukemia. These platinum agents and alkylating agents have been linked to the condition. Patients undergoing chemotherapy for extended numbers of years can develop myelodysplastic syndrome before it develops into AML. Platinum medications include carboplatin and cisplatin. Alkylating agents include carmustine, busulfan, melphalan, chlorambucil, procarbazine, mechlorethamine, and cyclophosphamide.
- Exposure to Radiation – Individuals who are exposed to high doses of radiation (survivors of nuclear reactor accidents or atomic bomb blasts) are known to have an increased risk of developing acute myeloid leukemia. However, radiation used to treat cancer has also been linked to the potential risk of AML. Additionally, a fetus exposed to elevated levels of radiation during the first trimester may have an increased potential risk of developing leukemia.
- Some Blood Disorders – Certain blood disorders are believed to increase the potential risk of developing acute myeloid leukemia including chronic myeloproliferative conditions including idiopathic myelofibrosis, essential thrombocythemia, and polycythemia vera.
- Genetic Syndromes – Syndromes known to be caused by abnormal cell changes (genetic mutations) present at birth can cause an increased potential risk of developing AML. These include:
- Bloom-Torre-Machacek syndrome
- Neurofibromatosis Type I
- Fanconi anemia
- Diamond-Blackfan anemia
- Lu-Fraumeni syndrome
- Schwachman-Diamond Syndrome
- Kostmann disease (severe congenital neutropenia)
- Triomy 8
- Down syndrome
- Genetic Predisposition – A family history (genetic predisposition) to AML is not thought to cause many cases of the condition. However, close relatives including siblings and parents with AML will likely affect the potential risk of acquiring the disease.
- Age – While the condition can the acquired at any age, older individuals seem to develop AML more than younger males and females.
- Gender – Males are more likely to develop acute myeloid leukemia than females. However, no apparent reason why it is understood.
- Unproven Risk Factors – Some research indicates that exposure to electromagnetic fields, exposure to workplace solvents and chemicals, and exposure to pesticides and herbicides are thought to be linked to the condition.
During the initial and developing stages of acute myeloid leukemia, patients often feel as though they are suffering from the flu or other illnesses. The most common AML symptoms include:
- Feeling tired
- Unexpected weight loss
- Loss of appetite
- Night sweats
- Irregular heartbeat
- Pale skin
- Shortness of breath
- Achy muscles
- Easy bruising
- Small red spots under the skin
- Bleeding gums
- Uncontrollable bleeding
- Sores that will not heal
- Swollen abdomen
- Swollen bleeding gums
- Joint or bone pain
- Numbness in the face
- Swollen glands and the underarms and groin area
- Balance issues
- Blurred vision
Diagnosing Acute Myeloid Leukemia
A doctor diagnosing acute myeloid leukemia will often look for certain indicators that suggest the individual has the disease. However, confirmation of the condition requires extensive tests. This includes obtaining a comprehensive medical history and completing a physical examination. The doctor will ask what symptoms the patient has been experiencing and whether they have any known risk factors.
The physical examination will include an evaluation of the nervous system, spleen, liver, lymph nodes, skin, mouth and any areas that show signs of infection, bruising or bleeding. The doctor will also take blood and bone marrow samples along with spinal fluid acquired through a spinal tap and perform laboratory tests to classify the condition. These tests could include:
- Complete Blood Count – This test can measure red blood cells, white blood cells and blood platelets in the bloodstream and determine how many of them are immature cells that are not functioning or maturing like normal.
- Blood Coagulation Tests – These groups of tests measure the levels of specific chemicals in the bloodstream in their capacity to clot blood when required. While the test is not actually diagnosed the condition and can assist in detecting kidney and liver problems, blood clotting issues, and abnormal levels of specific minerals in the bloodstream.
- Microscopic Examinations – Using a microscope, the laboratory pathologist can examine the shape, size and other special traits of white blood cells and determine if they are normal or immature.
- Cytochemistry – These tests use chemical dyes (stains) that react to specific leukemia cells that can be viewed under a microscope to help distinguish between normal cells, acute myeloid leukemia cells, and acute forms of the devastating condition.
Treating the Condition
Because AML is not just one disease, doctors must treat each form with unique symptoms until the disease's specific type has been confirmed. Typically, the doctor will recommend chemotherapy together with targeted therapy medication treatments. Once the chemotherapy is initiated, the doctor may recommend a stem cell transplant.
Nearly all forms of acute myeloid leukemia can progress rapidly. Because of that, it is essential to begin treatment as quickly as possible once a diagnosis has been confirmed. Many patients participate in clinical trials when new medications and chemotherapy treatments are in their initial stage before they are made available to the general population.