Adult acute myeloid leukemia

What is adult acute myeloid leukemia?

Adult acute myeloid leukemia (AML) is a disease in which cancer (malignant) cells are found in the blood and bone marrow. AML is also called acute nonlymphocytic leukemia or ANLL. The bone marrow is the spongy tissue inside the large bones in the body. The bone marrow makes:

• red blood cells (which carry oxygen and other materials to all tissues of the body)
• white blood cells (which fight infection)
• platelets (which make the blood clot)

Normally, the bone marrow makes cells called blasts that develop (mature) into several different types of blood cells. Each have specific jobs to do in the body. AML affects the blasts that are developing into white blood cells called granulocytes.

In AML, the blasts do not mature and become too numerous. These immature blast cells are then found in the blood and the bone marrow. Leukemia can be acute (progressing quickly with many immature blasts) or chronic (progressing slowly with more mature looking cancer cells). Acute myeloid leukemia progresses quickly. AML can occur in adults or children.

Symptoms

AML is often difficult to diagnose. The early signs may be similar to the flu or other common diseases. A doctor should be seen if the following signs or symptoms won't go away:

• Fever
• Weakness
• Tiredness
• Achiness in the bones or joints

Diagnosis

If there are symptoms, a doctor may order blood tests to count the number of each of the different kinds of blood cells. If the results of the blood tests are not normal, a doctor may do a bone marrow biopsy . During this test, a needle is inserted into a bone and a small amount of bone marrow is taken out and looked at under a microscope. A doctor can then tell what kind of leukemia is present and plan the best treatment. The chance of recovery (prognosis) depends on the type of AML and the patient's age and general health.

Stages of adult acute myeloid leukemia

There is no staging for AML. The choice of treatment depends on whether the patient has been treated.

Untreated

Untreated AML means no treatment has been given except to treat symptoms. There are too many white blood cells in the blood and bone marrow, and there may be other signs and symptoms of leukemia. Rarely, tumor cells can appear as a solid tumor called an isolated granulocytic sarcoma or chloroma.

In remission

Treatment has been given, and the number of white blood cells and other blood cells in the blood and bone marrow is normal. There are no signs or symptoms of leukemia.

Recurrent/refractory

Recurrent disease means the leukemia has come back after going into remission. Refractory disease means the leukemia has not gone into remission following treatment.

Treatment

There are treatments for all patients with AML. The primary treatment of AML is chemotherapy. Radiation therapy may be used in certain cases. Bone marrow transplantation and biological therapy are being studied in clinical trials.

• Chemotherapy
  Chemotherapy is the use of drugs to kill cancer cells. Drugs may be given by mouth, or they may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. Chemotherapy may sometimes be put into the fluid that surrounds the brain through a needle in the brain or back (intrathecal chemotherapy).
• Radiation therapy
  Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation for AML usually comes from a machine outside the body (external radiation therapy). If the leukemia cells have spread to the brain, radiation therapy to the brain or intrathecal chemotherapy will be given. There are two phases of treatment for AML. The first stage is called induction therapy . The purpose of induction therapy is to kill as many of the leukemia cells as possible and make patients go into remission.
  
  Once in remission with no signs of leukemia, patients enter a second phase of treatment (called continuation therapy ), which tries to kill any remaining leukemia cells. Chemotherapy may be given for several years to keep a patient in remission.
• Bone marrow transplantation
  Bone marrow transplantation is used to replace the bone marrow with healthy bone marrow. First, all of the bone marrow in the body is destroyed with high doses of chemotherapy with or without radiation therapy. Healthy marrow is then taken from another person (a donor) whose tissue is the same as or almost the same as the patient's. The donor may be a twin (the best match), a brother or sister, or a person who is not related. The healthy marrow from the donor is given to the patient through a needle in the vein, and the marrow replaces the marrow that was destroyed. A bone marrow transplant using marrow from a relative or from a person who is not related is called an allogeneic bone marrow transplant .
• Autologous bone marrow transplant
  Another type of bone marrow transplant, called autologous bone marrow transplant, is being studied in clinical trials. To do this type of transplant, bone marrow is taken from the patient and treated with drugs to kill any cancer cells. The marrow is then frozen to save it. Next, high-dose chemotherapy is given with or without radiation therapy to destroy all of the remaining marrow. The frozen marrow that was saved is then thawed and given to the patient through a needle in a vein to replace the marrow that was destroyed.
• Peripheral blood stem cell transplant
  Another type of autologous transplant is called a peripheral blood stem cell transplant. The patient's blood is passed through a machine that removes the stem cells (immature cells from which all blood cells develop), then returns the blood to the patient. This procedure is called leukapheresis and usually takes three or four hours to complete. The stem cells are treated with drugs to kill any cancer cells and then frozen until they are transplanted to the patient. This procedure may be done alone or with an autologous bone marrow transplant. A greater chance for recovery occurs if the doctor chooses a hospital that does more than five bone marrow transplantations per year.
• Biological therapy
  Biological therapy tries to get the body to fight cancer. It uses materials made by the patient's body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier therapy or immunotherapy.

Treatment by stage

Treatment for adult AML depends on the type of AML, the patient's age and overall health. Standard treatment may be considered based on its effectiveness in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy, and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most stages of adult AML. For more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Untreated adult acute myeloid leukemia

Treatment will probably be systemic chemotherapy. If leukemia cells are found in the brain, chemotherapy will be injected directly into the spinal cord (intrathecal). Clinical trials are testing new drugs.

Adult acute myeloid leukemia in remission

Treatment will most likely be:

• Systemic chemotherapy
• A clinical trial evaluating new chemotherapy
• Drugs and new ways of giving drugs
• A clinical trial evaluating bone marrow or peripheral stem cell transplantation

Recurrent adult acute myeloid leukemia

Radiation therapy may be given to reduce symptoms. Patients may also choose to take part in clinical trials of new chemotherapy drugs or bone marrow transplantation.