Acute myeloid leukaemia (AML)

Acute myeloid leukaemia (AML)
International Classification (ICD) C92.00

Basics

Leukemia - a diagnosis that probably shocks everyone at first, even though there have been decisive successes in recent years in the development of more effective treatments against blood cancer.

However, the prognosis depends very much on the particular form of leukaemia. Basically, a distinction is made between acute lymphatic leukaemia (ALL) and acute myeloid leukaemia (AML). While ALL mainly affects children, 80% of patients with AML are adults.

Definition of acute myeloid leukemia

If you translate the name of the disease accurately, you already know what it is. On the one hand, the name "leukemia" reveals that leukocytes (white blood cells) are altered, which is why they are found in increased numbers in the blood (-emia). The addition myeloid indicates that the myeloid series of blood formation is affected. This gives rise to special forms of leukocytes, such as the so-called granulocytes and monocytes. Both contribute significantly to the body's immune defenses.

Acute myeloid leukaemia is therefore a malignant disease of blood formation in which increased numbers of myeloid cells and their precursors are formed and flushed out of the bone marrow. As a result, not only are there functionless precursors in the blood, but other blood cells are also disturbed in their development.

Distribution of acute myeloid leukaemia

AML is a very rare disease, with about three new cases per 100,000 inhabitants per year. It mainly affects people of advanced age. Men are affected somewhat more frequently than women. However, in addition to the elderly, newborns and infants also usually suffer from AML when they develop leukaemia.

Causes

The causes of cancer are usually very diverse, and it is difficult to determine which factor was decisive for the disease. This is because it is always a whole network of circumstances, predispositions and damage that ultimately lead to a person becoming ill with leukaemia.

Genetic predisposition

Even though the exact development of leukaemia has still not been researched in detail, it can be said that certain genetic conditions facilitate the development of leukaemia. These include, for example, trisomy 21 (Down syndrome) or Fanconi syndrome.

Leukaemia due to radiation damage

Ionizing radiation also plays a role in leukemia that should not be underestimated. Therefore, it is essential to avoid unnecessary exposure to radiation. This does not mean mobile phone radiation or microwaves, no, it is mainly about X-rays and radioactive radiation. Both can change the cells and their blueprint in such a way that the blood stem cells divide uncontrollably and leukaemia develops.

How viruses can cause cancer

Although it may sound absurd at first glance, leukaemia can also be caused by viruses. On the one hand, there are specific viruses that directly trigger cancer when infected, but on the other hand, many non-specific viruses can also help a cell to become malignant.

This is because every virus needs a cell in order to be able to multiply. However, a healthy cell has its own safety systems that prevent too frequent cell division. This is because with every division there is of course the danger that an error will occur during the transcription of the genetic material, which can then lead to a malfunction or to uncontrolled division. Many viruses try to override these safety systems in order to be able to reproduce themselves better. And by doing so, they also facilitate the development of cancer.

Other factors in the development of leukaemia

In addition, chemical substances such as benzene, various drugs or pre-existing haematological diseases can also play a role in the development of leukaemia.

Symptoms

AML is a disease of the hematopoietic system and therefore affects the entire organism. The symptoms of the disease are therefore very varied and differ from person to person. Almost anything can indicate leukemia, but there are hardly any definite symptoms.

Anemia due to displacement

Often there is the development of anemia, which is a deficiency of red blood cells. This is because their formation is displaced by the degenerated white blood cells. As a result, less oxygen can be transported, which leads to shortness of breath, weakness and pallor.

Pain in bones and abdomen

Pain that occurs without a specific cause can also be caused by leukaemia. Here too, the excessive formation of lymphocytes in the bone marrow and the increased work in the spleen and liver play a major role.

Other symptoms

In addition to these more typical signs, there can also be skin changes, night sweats, weight loss, hematomas, skin bleeding, increased infections, headaches and neurological deficits. Basically, anything can indicate leukemia, which is why it is important to consult a doctor at the slightest hint.

Diagnosis

As has just been discussed, symptomatology is not a sufficient indication of the presence of AML. Instead, other tests must be performed. For example, a physical examination will look for enlargement of the liver, spleen, or lymph nodes.

Laboratory values

Laboratory values can provide a good indication, even if there are often not very typical changes here. For example, the leukocytes can be increased, decreased or even in the normal range. The red blood cells and platelets can be reduced, but do not have to be. The same applies to liver and kidney values, electrolytes and clotting factors. A really concrete indication is provided only by the so-called blastic precursors, which should not actually be found in the blood. These are only released from the bone marrow when leukaemia is present.

Bone marrow puncture

Even though this is extremely unpleasant, a bone marrow puncture must be carried out in order to confirm the diagnosis. The material taken is then examined in detail by special laboratories in order to determine the type of leukaemia.

Further additional examinations

In order to further confirm the diagnosis and, above all, to determine which organs are already affected by the leukaemia, X-rays of the chest and an ultrasound of the abdomen are taken. In addition, a lumbar puncture is usually performed, in which some cerebrospinal fluid is taken through a puncture in the back.

Therapy

During therapy, it is essential to ensure a low-germ environment, which is why special hygiene measures must be observed. If a germ does get into the organism, it must be treated quickly with broad-spectrum antibiotics. To improve the quality of life, an infusion with blood components (erythrocytes or thrombocytes) can be given if necessary.

Chemotherapy in several cycles

The focus of therapy is, of course, chemotherapy, which proceeds in several cycles. Induction therapy, the first cycle, attempts to achieve remission. This means that the degenerated leukemia cells are reduced by 95%. This is followed by consolidation and reinduction therapy, which can last up to a year in several cycles. However, this long treatment period is necessary in order to prevent a new development of AML.

Alternative measures

As an alternative or in addition to chemotherapy, radiation or stem cell transplantation may be performed. However, this must be decided as such for each case, as many factors play a role.

Forecast

The prognosis varies from case to case. However, a cure rate of 50-60% can be achieved. This may sound bad, but it must be remembered that acute myeloid leukemia mainly affects old people. And these usually already have a poor state of health anyway, which makes the cure difficult. Therefore, the focus here is on ensuring that the remaining time can be spent as actively as possible.

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