Limbic 365Acute Myelogenous Leukemia (AML) is a type of cancer that affects the blood and bone marrow. It occurs when the bone marrow produces abnormal white blood cells that grow uncontrollably and interfere with the production of normal blood cells. AML is a rapidly progressing disease that requires prompt diagnosis and treatment.
Case:
A 55-year-old man presents to the hospital with fatigue, fever, and bruising all over his body. On examination, he has pale skin, enlarged liver and spleen, and multiple petechiae on his skin. He also reports recent weight loss and shortness of breath on exertion. His blood tests show low platelets and red blood cells, high white blood cells, and abnormal cells in his bone marrow biopsy. The patient is diagnosed with AML.
Pathophysiology:
AML arises from mutations in bone marrow cells that lead to the formation of abnormal white blood cells, including myeloblasts, promyelocytes, and other immature cells. These cells do not mature normally and accumulate in the bone marrow, interfering with the production of normal blood cells. The abnormal cells also infiltrate other organs, leading to various symptoms and complications.
Signs and Symptoms:
AML can cause a range of symptoms, including:
Fatigue, weakness, and pale skin due to low red blood cells
Easy bruising, bleeding, and frequent infections due to low platelets
Fever, night sweats, and weight loss
Enlarged liver and spleen
Bone pain and joint pain
Shortness of breath and chest pain
Petechiae (tiny red or purple spots) on the skin
Investigations:
To diagnose AML, the following tests may be performed:
Complete blood count (CBC) to assess the levels of red blood cells, white blood cells, and platelets
Blood smear to examine the appearance of blood cells under a microscope
Bone marrow biopsy and aspiration to examine the bone marrow cells and identify abnormal cells
Cytogenetic analysis to look for specific chromosomal abnormalities that can help guide treatment decisions
Lumbar puncture to check for leukemia cells in the cerebrospinal fluid (CSF) if the patient has neurological symptoms
Treatment:
The treatment of AML depends on the patient’s age, overall health, and the subtype of the disease. The main options are:
Chemotherapy: This is the standard treatment for AML, and it involves using drugs to kill the abnormal cells in the bone marrow. Chemotherapy may be given in cycles, with breaks in between to allow the body to recover. Depending on the response to treatment, a bone marrow transplant may be recommended.
Bone marrow transplant: This involves replacing the patient’s bone marrow with healthy donor cells. This is usually reserved for patients with high-risk disease or those who do not respond well to chemotherapy.
Targeted therapy: This is a newer approach that involves using drugs that specifically target the genetic mutations in the cancer cells. This may be used in combination with chemotherapy.
Supportive care: This includes measures to manage the side effects of treatment, such as infection prevention, blood transfusions, and pain management.
Dos and Don’ts:
Do follow the treatment plan recommended by your doctor and attend all appointments and tests.
Do report any new symptoms or side effects to your doctor promptly.
Do practice good hygiene to reduce the risk of infections.
Do eat a healthy diet and exercise as recommended by your doctor.
Don’t smoke or use tobacco products.
Don’t take any new medications or supplements without consulting your doctor.
Don’t delay seeking medical attention if you develop symptoms or complications.
Reference:
American Cancer Society. (2021). Acute Myeloid Leukemia
National Cancer Institute. Adult Acute Myeloid Leukemia Treatment (PDQ®) – Health Professional Version. Retrieved from https://www.cancer.gov/types/leukemia/hp/adult-aml-treatment-pdq
American Society of Hematology. Acute Myeloid Leukemia. Retrieved from https://www.hematology.org/education/patients/leukemia/aml
Mayo Clinic. Acute myelogenous leukemia (AML). Retrieved from https://www.mayoclinic.org/diseases-conditions/acute-myelogenous-leukemia/symptoms-causes/syc-20369167
Leukemia & Lymphoma Society. Acute Myeloid Leukemia. Retrieved from https://www.lls.org/disease-information/acute-myeloid-leukemia
Cancer Research UK. Acute myeloid leukaemia (AML). Retrieved from https://www.cancerresearchuk.org/about-cancer/acute-myeloid-leukaemia-aml
