Home
Acute myeloid leukaemia

Acute myeloid leukaemia (AML) symptoms

All the symptoms described also occur in the context of other, comparatively harmless diseases and in most cases are not associated with leukemia. If symptoms persist, however, it is advisable to have the cause clarified by a physician. If there is indeed acute myelogenous leukemia, a therapy must be started as soon as possible.

Diagnosis of AML

In the case of suspected leukemia extensive examinations of the blood and bone marrow are necessary in order to first confirm the diagnosis and subsequently determine the type of leukemia. By means of so-called imaging methods , the extent of the disease is also determined.

If the physician / internist finds evidence of an acute leukemia due to illness and physical examinations, he will first examine the blood . If the suspicion of leukemia is confirmed, for example, because immature cells are found in the blood, anemia or thrombopenia is present, the diagnosis must also be assured by the analysis of the bone marrow. Such an examination is carried out at a specialized hospital by a specialist for blood and cancer (hematologists / oncologists). He removes bone marrow from the hip bone or bone (bone marrow) with a syringe under local anesthesia. This short outpatient procedure can be a bit unpleasant for the patient as it takes a few minutes for the bone marrow to enter the syringe.

The subsequent laboratory studies of bone marrow include the biological properties, external cell features and genetic changes of the infected cells. With the help of the analysis, the exact subform of the disease can be determined in addition to the type of leukemia. Because the subforms of acute myelogenous leukemia differ significantly in their course of disease, prognosis, and response to different therapy, the in-depth study of bone marrow is crucial to develop a suitable plan for the treatment.

When an AML is detected, additional examinations are necessary depending on the individual case in order to rule out the involvement of other organs of the body with blasts. These include chest radiographs, computer tomography and ultrasound examination of the abdomen and heart. In exceptional cases a sample is taken from the spinal fluid ( lumbar puncture ) to determine if there is leukemia in the brain.

In the further course after the start of therapy, bone marrow punctures and other control examinations are always necessary. For example, MRD diagnostics can be used to check whether the leukemia has completely re-formed (remission).

Classification of AML

Acute myelogenous leukemia is not a uniform disease, but rather a group of different subforms, which can be distinguished from each other by their biological properties, external cell features and genetic changes. The assignment to a certain subform plays an important role for the therapy decision since the different subforms differ from one another in terms of the course of the disease and the chances of healing (prognosis) and are differently sensitive to chemotherapy. Basically, one distinguishes between primary and secondary AML: If the AML occurs independently and without previous bone marrow or cancer diseases, one speaks of a primary or de novo AML. A secondary AML develops from another bone marrow disease (eg a myelodysplastic syndrome ) or arises as a result of an earlier chemotherapy or radiation therapy. Since the secondary AML is usually associated with several genetic changes, it has a poorer prognosis than the primary AML.
The classification of AML nowadays is mostly based on the WHO classification . This combines the older FAB classification, in which the blasts are subdivided into eight subgroups (M0-M7) according to their external, microscopically visible traits, with genetic features of the leukemic cells. The external characteristics as well as the underlying genetic changes can be determined by means of comparative laboratory tests such as microscopy, cytochemistry, immunophenotyping, molecular genetics, cytogenetics or in situ hybridization.

Acute promyelocytic leukemia (APL)

Acute promyelocytic leukemia (APL) is a rare subform of AML diagnosed in approximately 5% of AML patients. In this disease, a special genetic change can be detected, which is called translocation t (15; 17). It leads to the formation of the defective protein PML-RARA, which is causally involved in the development of the disease. The APL has a special role with regard to the course of the disease, the prognosis and the treatment. The disease occurs mainly in younger patients and is associated with a good prognosis. By combining chemotherapy with all-trans-retinoic acid (ATRA), which stimulates leukemia cells, more than 75% of patients can now be cured. A prerequisite is, however, the treatment in a specialized leukemia center, because the APL often causes a disturbance of the blood coagulation and is therefore associated with a high rate of bleeding complications.

Treatment of acute myelogenous leukemia

AML is a serious condition that leads to death untreated within a few weeks. It is therefore extremely important that a therapy be initiated immediately after the diagnosis. The most important component of the treatment is the chemotherapy with an accompanying therapy for the treatment of the side effects. For this purpose, a bone marrow transplant may occur in a particular case. Radiation therapy plays a subordinate role at AML. All components of the therapy serve to kill the leukemia cells as completely as possible in the body, so that the bone marrow can resume its original function - the formation of blood.

The treatment of an AML should be carried out at a clinic with experience in the treatment of leukemia, especially the AML. The clinic should have access to the latest state of research and carry out the necessary special examinations. You can find out more about the right clinic here . Because the treatment is lengthy and burdensome, patients and their relatives should inform themselves thoroughly about the planned procedure. The treating physician will speak with the patient in detail and inform him about all treatment options.

chemotherapy

In chemotherapy , a patient receives drugs called cytotoxic drugs that specifically inhibit the growth of leukemia cells. Since a single drug is usually not sufficient to destroy all blasts, several drugs are combined with different actions. They are given as an infusion, syringe or in the form of tablets. Chemotherapy is divided into several cycles separated by breaks (intervals) in which healthy cells can regenerate. To assess the success of the therapy, the bone marrow and other infected regions are checked at regular intervals.

stem cell

Another possibility of treatment is stem cell transplantation . The aim of this therapy is to replace the diseased bone marrow with healthy ones. In the case of stem cell transplantation, purified blood stem cells of a suitable donor (allogene) or more infrequently of the patient themselves (autolog) are administered to the patient by infusion. For successful therapy, all leukemia cells must first be killed. This is achieved by a strong chemotherapy and an irradiation which, in addition to the blasts, also destroys the healthy cells in the bone marrow. Since this is a stressful and risky treatment, the patient has to be considered for stem cell transplantation with regard to general condition and age. Stem cell transplantation is usually carried out only if, due to the characteristics of the leukemia cells, it must be assumed that a high risk of a relapse (recurrence) exists or if the chemotherapy has not brought sufficient treatment success.

treatment studies

Treatment of AML patients should be performed as far as possible in the context of therapies . The patient is given access to the latest scientific knowledge and is treated with innovative medicines and according to current treatment strategies. Participation in a study does not mean that the use of the drugs used is experimental. Rather, the goal is to improve the treatment strategies of AML in the future. The decision about which study is appropriate for a patient must be discussed intensively with the treating physician. Various criteria such as disease characteristics, disease phase, pretreatment, age and risk factors play a role. However, the final decision is always made by the patient himself. In Germany, numerous clinics participate in the studies of the German study groups for adult AML . The current studies can be found in the German Leukemia Study Registry .

Treatment options for a relapse

In the event of a relapse of the AML, chemotherapy is again carried out again. In late relapses, the induction therapy can be repeated in order to achieve a complete destruction of the leukemia cells (remission). In early relapses or when the disease does not respond to the therapy (therapy failure), different possibilities are explored eg with new medicines within the framework of therapy studies. Here, it is important that the treating physicians are informed about all currently available therapeutic options. The goal is to achieve a complete remission. Frequently, when age and general condition permit and when a donor can be found, stem cell transplantation is performed.



aftercare

The number of cures has been growing steadily at AML over the past decades. However, regular follow-up examinations are necessary. They include a general physical examination as well as controls of blood and bone marrow. The aim is to detect signs of a relapse or late-onset of the therapy at an early stage. With the distance from the diagnosis and the therapy end, the intervals between the examinations are then extended. The treating physician also advises on the possibility of rehabilitation (rehabilitation). It is usually funded by the health insurance companies and offers a good transitional opportunity to return to a "normal" life.