1. Symptoms
1.1. The signs or symptoms of leukemia may vary depending on whether you have an acute or chronic type of leukemia. Acute leukemia may cause signs and symptoms that are similar to the flu. They come on suddenly within days or weeks. Chronic leukemia often causes only a few symptoms or none at all. Signs and symptoms usually develop gradually. People with a chronic leukemia often complain that they just do not feel well. The disease is often found during a routine blood test
2. Treatments
2.1. Treatment is usually given in 2 phases, called induction and consolidation.
2.1.1. Induction
2.1.1.1. Chemotherapy is the main induction treatment for AML. Most regimens are built around the drug cytarabine and daunorubicin which may be combined with other drugs or agents.
2.1.1.1.1. Older people with AML who may not benefit from standard therapy or who cannot cope with the side effects of the drugs commonly used in induction treatment may be given low-dose cytarabine
2.1.2. Consolidation:
2.1.2.1. Consolidation treatment is also called post-remission therapy. The goal of consolidation treatment for AML is to prevent leukemia cells from coming back. It is done to maintain complete remission and prevent relapse.
2.1.2.1.1. Chemotherapy is also the main consolidation treatment for AML. Chemotherapy is given soon after remission has been reached (2–3 weeks after blood cell counts return to normal). Treatment involves repeating cycles of the same or similar drugs used to bring about the remission. Similar or higher doses of the drugs may be used. The most common consolidation regimens for AML include cytarabine alone or combined with an anti-tumour antibiotic
3. Complications
3.1. Graft Versus Host Disease
3.1.1. Graft-versus-host-disease (GVHD) can happen after an allogeneic stem cell transplant. The stem cells from the donor develop into a new immune system that will identify and destroy cancer cells. But it can also attack your healthy cells and cause damage to tissues and organs. Some people who have an allogeneic transplant never get GVHD. The closer the donor’s stem cells match yours, the less likely it is that you will develop GVHD. Those who do get it will have acute GVHD or chronic GVHD or both. GVHD can be mild to very severe.
3.1.1.1. Acute GVHD
3.1.1.1.1. Acute GVHD usually happens in the first 100 days after an allogeneic stem cell transplant. It often affects the skin, liver and intestines but may affect other organs too.
3.1.1.2. Chronic CVHD
3.1.1.2.1. Chronic GVHD usually starts 100 or more days after an allogeneic stem cell transplant. It can last a few months or a lifetime. Chronic GVHD can happen right after you have had acute GVHD or after a time with no symptoms. It can also develop if you haven’t had acute GVHD.
3.1.2. MANAGEMENT / TREATMENT
3.1.2.1. To help prevent GVHD, doctors may remove some of the immune cells that cause GVHD before the stem cell transplant (called T-cell depletion). You may need to take drugs that suppress the immune system to prevent or treat GVHD. You may take these drugs for months or years after an allogeneic transplant.
3.1.2.1.1. The main drug combination given to prevent GVHD or decrease its severity is cyclosporine (Neoral) and methotrexate. Alternating cyclosporine and prednisone every other day is a common treatment.
3.2. Veno-Occlusive Disease
3.2.1. Veno-occlusive disease (VOD), which is also called sinusoidal obstruction syndrome (SOS), happens when the small blood vessels that lead into the liver and are inside the liver become blocked. VOD is caused by high doses of chemotherapy and radiation therapy given before an allogeneic stem cell transplant. It develops in the first few weeks after a stem cell transplant and can be mild to severe.
3.2.1.1. SYMPTOMS
3.2.1.1.1. jaundice liver tenderness (under the ribs on the right side of the body) ascites sudden weight gain liver enlargement liver failure
3.2.1.2. MANAGEMENT / TREATMENT
3.2.1.2.1. The drug defibrotide (Prociclide) may be used to prevent or treat VOD. Most people have mild to moderate VOD. Some people recover without treatment within a few weeks or after they get more of the drugs given to suppress the immune system. Sometimes VOD is severe and can lead to liver failure. If this happens, a liver transplant may be needed.
4. Cancer Related Emergencies
4.1. In some cases, leukemia or its treatments can cause serious problems. These cancer-related emergencies need to be treated right away.
4.1.1. Tumour lysis syndrome can occur when chemotherapy is given to treat acute leukemia, but the cancer cells die quickly and the kidneys can’t remove the substances they release from the blood fast enough.
4.1.2. Disseminated intravascular coagulation (DIC) is a condition where blood clots develop in the bloodstream and bleeding also occurs. DIC can develop more often with acute promyelocytic leukemia, but also with other subtypes of acute myelogenous leukemia (AML).
5. What is AML?
5.1. Acute myelogenous leukemia (AML) is a cancer that starts in blood stem cells. As the stem cells of the blood develop, they become blast cells (blasts), which are immature blood cells. In leukemia, there is an overproduction of blast cells. These blast cells develop abnormally and don’t develop into mature blood cells. Over time, the blast cells crowd out normal blood cells so that they can’t do their jobs. When leukemia is diagnosed, these blast cells may be called leukemia cells.
6. Diagnosis
6.1. Diagnosing leukemia usually begins with a visit to your family doctor or when a routine test suggests a problem with the blood. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for leukemia or other health problems.
6.2. The following tests are commonly used to rule out or diagnose leukemia. Many of the same tests used to diagnose cancer are used to find out the stage, which is how far the cancer has progressed. Your doctor may also order other tests to check your general health and to help plan your treatment
6.2.1. Health history and physical exam
6.2.2. Complete blood count (CBC)
6.2.3. Blood chemistry tests
6.2.4. Bleeding and clotting factors
6.2.5. Cytochemistry
6.2.6. Immunophenotyping
6.2.7. Cytogenetic and molecular studies
6.2.8. Bone marrow aspiration and biopsy
6.2.9. Lumbar puncture
6.2.10. Lymph node biopsy
7. Stem Cell Transplant for AML
7.1. Some people with AML will have a stem cell transplant. Stem cells are found in the bone marrow, the bloodstream and umbilical cords. They are basic cells that develop into different types of cells that have different jobs. For example, all our blood cells develop from blood stem cells. A stem cell transplant is used to replace stem cells when stem cells or bone marrow are damaged. They can be damaged by disease or destroyed by high doses of chemotherapy or radiation therapy. You may be offered a stem cell transplant to treat AML: - during first complete remission - after an early relapse and second complete remission is reached A stem cell transplant is a very risky and complex procedure that must be done in specialized transplant centres or hospitals.
7.2. Allogenic
7.2.1. In this type of transplant, the stem cells are taken from one person (the donor) and are given to another person (the recipient). The donor may be a relative or may be unrelated to the recipient. The donor and recipient are matched through a process called human leukocyte antigen (HLA) typing.
7.3. Autologous
7.3.1. In this type of transplant, the stem cells are taken from your own bone marrow or blood. An autologous transplant is sometimes used if there is no matched donor.