Acute myeloid leukemia
Acute myeloid leukemia (AML) is a rare, malignant disease of the hematopoietic system. The bone marrow (medulla ossium) is primarily affected here, in which red ( erythrocytes ) and white ( leukocytes ) blood cells are formed.
A so-called differentiation block takes place in the bone marrow. Immature blood cells (blasts) accumulate in the blood and bone marrow, which (to put it very simply) leads to a suppression and suppression of normal blood formation.
The most important facts briefly summarized:
- Acute myeloid leukemia is a malignant disease of the hematopoietic system.
- If left untreated, this disease leads to death.
- Acute myeloid leukemia Symptoms : The first signs are unspecific symptoms such as increasing physical weakness, paleness and susceptibility to infections.
- Acute myeloid leukemia is primarily treated with chemotherapy drugs and stem cell transplantation.
- Acute myeloid leukemia Course: The chances of remission decrease with increasing age.
As a result, due to a lack of capacity, more immature cells are increasingly released into the bloodstream, which cannot or only insufficiently take on their actual tasks.
Functional blood cells are missing in the short and medium term. This disease occurs in about three quarters of all cases in old age. Left untreated, it leads to death.
Acute myeloid leukemia Course and forms of the disease
Acute myeloid leukemia and its forms are classified in different ways depending on the publishing society.
Prerequisite for a typing are corresponding extensive laboratory tests of the blood. The proposals of the French-American-British Cooperative Group (FAB), which distinguish acute myeloid leukemia according to differentiation, maturation and other forms, found widespread use.
The different forms are represented according to the term M0 to M7.
In recent years, the definition of the World Health Organization (WHO), which takes into account the characteristics of AML blasts and differentiates them more specifically, has been gaining acceptance.
Acute myeloid leukemia symptoms
Initially, acute myeloid leukemia shows symptoms that are in the acute, more general range, which occur with a rather short lead time, usually within a few weeks.
It can happen that these symptoms are initially misinterpreted. The signs of the disease arise due to the disrupted formation of blood (hematopoiesis) and the resulting displacement process.
Acute myeloid leukemia shows these symptoms or can manifest themselves as follows:
- Those affected often notice non-specific signs such as tiredness, exhaustion, reduced performance, shortness of breath, night sweats, diffuse digestive problems with loss of appetite. Due to the anemia, a clear paleness is often noticeable.
- Children in particular have a very clear lack of desire to play and a general lack of interest.
- Due to the lack of functional white blood cells (leukocytes), a general susceptibility to infection builds up, which is characterized by the occurrence of fungal infections in the mouth (thrush). These fungal infections can in turn occur in a generalized manner and spread to other organs. This susceptibility to infection is often accompanied by fever. Tonsillitis is not uncommon.
- Pneumonia can develop as a further sign of a tendency to infections.
- Another visible symptom is the increased tendency to bleed, prolonged nosebleeds, punctiform or patchy bleeding under the skin (petechiae, ecchymoses), bleeding from the gums and mucous membranes and increased or prolonged menstrual bleeding in women can be possible consequences. These are caused by a clotting disorder due to a lack of blood platelets (thrombocytes).
- Further, as the disease progresses, there is a possibility that immature leukocytes in the blood will increase significantly. This can lead to neurological symptoms (paraesthesia, pain, severe itching and tingling, headaches, stiff neck, blurred vision), to a general undersupply of the organism with oxygen and bleeding into the retina.
- Swelling of the lymph nodes and enlargement of the liver, testicles and spleen are other possible side effects.
- Due to the spread of the pathological cell types (blasts) in joints and bones, corresponding pain symptoms are possible there. Children who were previously able to walk are now increasingly refusing to do so and increasingly want to be carried.
Acute myeloid leukemia symptoms – interpretation of the symptoms
Important: A large part of the symptoms described above are also present in many other, comparatively harmless diseases . The correct diagnosis by a doctor or oncologist is absolutely necessary and must be waited for.
Acute myeloid leukemia course
As described, AML (acute myeloid leukemia) is an acute disease with a correspondingly rapid course of the disease, which requires the immediate start of treatment (usually a chemotherapeutic approach and/or stem cell transplantation).
Acute myeloid leukemia shows symptoms such as an increase in the number of blast cells in the blood in a short period of time. These can settle accordingly in organs (liver, spleen).
The course of the disease is always fatal without therapy. Due to the pronounced weakening of the body’s immune system, this can happen just a few weeks after the first symptoms appear.
Acute myeloid leukemia course – possible complication
Occasionally, the so-called “tumor lysis syndrome” can occur. Due to the increase in potassium, uric acid, LDH and phosphate in the blood with a simultaneously reduced calcium level, kidney failure can occur, which can reach life-threatening proportions and urgently require intensive care measures.
With the start of therapy and its effectiveness, the course of the disease is differentiated according to the percentage of blasts in the bone marrow, the absence of certain deposits (Auer rods) in the cells, the absence of molecular changes and the presence of certain laboratory values.
This results in the following subdivision of the course:
- Morphologically leukemia-free condition
- Morphologic Complete Response (CR)
- Morphological complete remission with incomplete recovery (CRi/CRp)
- Cytogenetic Complete Response (CRc)
- Molecular Complete Response (CRm)
- Partial Remission (PR)
- Recurrence from CR
Acute myeloid leukemia prognosis of course
Based on various studies, the long-term survival rate of people suffering from AML depends on their age.
In patients under the age of 60 it is no more than 40 percent, in patients over 60 years it is no more than 20 percent (compare T. Buchner, “Treatment of older patients with AML”; Crit Rev Oncol Hematol 2005; 56(2): pages 247 to 259).
Acute myeloid leukemia Occurrence and treatment of relapse
After proof of a leukemia-free condition (remission; the term “cure” is only rarely and reluctantly used), regular and extensive checks are necessary in order to be able to recognize a possible return of the disease (recurrence) in good time and to be able to take appropriate countermeasures.
Particular risk factors for a recurrence include being older at the time of the first illness (55 years or older) or evidence of a so-called secondary AML. The controls include examinations of the bone marrow and the affected organic regions.
Despite a morphological complete remission (CR) after primary therapy, the majority of patients suffer a relapse. Depending on the study, rates of 50 to 80 percent are mentioned
(vergleiche hierzu John A. Liu Yin, Keith Wheatley,, John K. H. Rees, Alan K. Burnett: Comparison of ’sequential‘ versus ’standard‘ chemotherapy as re-induction treatment, with or without cyclosporine, in refractory/relapsed acute myeloid leukaemia (AML): results of the UK Medical Research Council AML-R trial; British Journal Of Haematology 2001, Ausgabe 113, Seiten 713 bis 726).
Recurrences occur more often either in the first twelve months after CR or in the first two years after the initial diagnosis. Even with recurrences, treatment of AML with chemotherapy or stem cell transplantation, often in combination, is necessary.
If these therapy options fail, a palliative approach, including infection prophylaxis and the supply of blood products, is indicated.
Sources:
- Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR, Sultan C.: Proposals for the classification of the acute leukaemias. French-American-British (FAB) co-operative group. Br J Haematol. 1976; 33(4): 451-8. (zu: Akute myeloische Leukämie Symptome)
- www.http://flexikon.doccheck.com/de/Akute_myeloische_Leuk%C3%A4mie; Access 03/2018
- Gerd Herold et al: Internal Medicine 2013, Herold-Verlag
- Karl Anton Kreuzer, Jörg Beyer: Hematology and concology: case-oriented presentation – rational diagnostics and therapy, Thieme Verlag, 1st edition 2016 ((to: Acute myeloid leukemia course)
- Gerhard Ehninger, Hartmut Link: Acute myeloid leukemia: pathophysiology, diagnostics, therapy, prognosis, Deutscher Ärzte Verlag, 1st edition 2008
