Acute myeloid leukaemia

Overview Of Acute myeloid leukaemia

Acute myeloid leukemia (AML) is a rapidly progressing cancer of the blood and bone marrow, characterized by the uncontrolled proliferation of immature white blood cells known as myeloblasts. These abnormal cells crowd out healthy blood cells, impairing the body's ability to produce normal red blood cells, white blood cells, and platelets. AML is the most common type of acute leukemia in adults, though it can occur at any age. The disease often manifests suddenly, with symptoms appearing within weeks or even days. Unlike chronic leukemias, which progress more slowly, AML requires immediate medical intervention due to its aggressive nature. The condition can arise de novo or as a result of prior chemotherapy or radiation therapy for other cancers. AML is classified into subtypes based on the specific genetic mutations and cellular characteristics, which influence treatment strategies and prognosis.

Causes of Acute myeloid leukaemia

• The exact cause of AML remains unclear, but it is linked to genetic mutations in the DNA of bone marrow cells. These mutations disrupt the normal process of cell differentiation and maturation, leading to the accumulation of immature blast cells. Several factors are known to contribute to these genetic alterations. Exposure to high levels of radiation, such as from nuclear accidents or certain medical treatments, significantly increases the risk. Chemical exposure, particularly to benzene and certain chemotherapy agents like alkylating agents and topoisomerase II inhibitors, is also a known risk factor. Additionally, pre-existing blood disorders, such as myelodysplastic syndrome (MDS) or myeloproliferative neoplasms, can evolve into AML. Inherited genetic syndromes, including Down syndrome and Fanconi anemia, further predispose individuals to this condition.

Risk Factors of Acute myeloid leukaemia

• Several factors increase the likelihood of developing AML. These include:
• Age: The risk of AML increases with age, particularly after
• Gender: Men are slightly more likely to develop AML than women.
• Previous Cancer Treatment: Exposure to chemotherapy or radiation therapy for other cancers is a significant risk factor.
• Chemical Exposure: Prolonged exposure to benzene and other industrial chemicals is strongly associated with AML.
• Smoking: Cigarette smoke contains carcinogens that can damage bone marrow cells.
• Blood Disorders: Conditions like MDS or polycythemia vera can progress to AML.
• Genetic Syndromes: Inherited disorders such as Down syndrome or Li-Fraumeni syndrome increase susceptibility.
• Family History: A family history of leukemia may slightly elevate the risk.

Prevention of Acute myeloid leukaemia

• Preventing AML is challenging due to its multifactorial etiology, but certain measures can reduce risk. Avoiding exposure to known carcinogens, such as benzene and tobacco smoke, is crucial. Individuals with a history of chemotherapy or radiation therapy should undergo regular monitoring for early signs of secondary AML. Genetic counseling may be beneficial for those with inherited syndromes predisposing them to leukemia. Maintaining a healthy lifestyle, including a balanced diet and regular exercise, may support overall bone marrow health. However, given the unpredictable nature of AML, early detection through routine blood tests and prompt medical attention for unexplained symptoms remain the most effective strategies for improving outcomes.

Prognosis of Acute myeloid leukaemia

• The prognosis of AML varies widely depending on factors such as age, overall health, genetic mutations, and response to treatment. Younger patients and those with favorable genetic markers, such as NPM1 mutations without FLT3-ITD, generally have better outcomes. The five-year survival rate for adults under 60 is approximately 40-50%, but this drops significantly for older adults. Achieving complete remission after induction therapy is a positive prognostic indicator, though the risk of relapse remains high. Advances in targeted therapies and HSCT have improved survival rates for certain subgroups. However, AML remains a challenging disease, particularly for older patients or those with high-risk genetic profiles.

Complications of Acute myeloid leukaemia

• AML can lead to severe complications due to the suppression of normal blood cell production and the infiltration of leukemia cells into other organs. Life-threatening infections are common due to neutropenia, while severe bleeding can result from thrombocytopenia. Organ dysfunction, such as hepatomegaly or splenomegaly, may occur as leukemia cells accumulate in these tissues. Disseminated intravascular coagulation (DIC), a condition characterized by abnormal blood clotting and bleeding, is a rare but serious complication. Treatment-related complications, including chemotherapy-induced cardiotoxicity or graft-versus-host disease (GVHD) following HSCT, further complicate management. Long-term survivors may experience secondary cancers or chronic health issues due to the intensity of treatment.

Related Diseases of Acute myeloid leukaemia

• AML is closely associated with several other hematologic conditions. Myelodysplastic syndrome (MDS) often precedes AML, particularly in older adults, and shares similar genetic mutations. Chronic myelomonocytic leukemia (CMML) and myeloproliferative neoplasms (MPNs), such as polycythemia vera and essential thrombocythemia, can also transform into AML. Acute lymphoblastic leukemia (ALL), another type of acute leukemia, differs in its origin from lymphoid cells but shares overlapping symptoms and treatment approaches. Other related conditions include aplastic anemia, which involves bone marrow failure, and paroxysmal nocturnal hemoglobinuria (PNH), a rare disorder associated with bone marrow dysfunction. Understanding these relationships is essential for accurate diagnosis and management of AML and its precursors.

Treatment of Acute myeloid leukaemia

The treatment of AML typically involves intensive chemotherapy, divided into two phases: induction and consolidation. Induction therapy aims to achieve remission by eliminating leukemia cells, often using a combination of cytarabine and an anthracycline. Consolidation therapy follows to eradicate any remaining cancer cells and prevent relapse. For patients with high-risk genetic mutations or those who relapse, hematopoietic stem cell transplantation (HSCT) may be recommended. Targeted therapies, such as FLT3 inhibitors (e.g., midostaurin) or IDH inhibitors (e.g., ivosidenib), are used for specific genetic subtypes. Supportive care, including antibiotics, antifungals, and blood transfusions, is essential to manage complications like infections and anemia. Clinical trials exploring novel therapies, such as immunotherapy or epigenetic modulators, offer additional options for refractory cases.