Understanding AML



A
cute Myelogenous Leukemia
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Acute myelogenous leukemia (AML) is a fast-growing cancer of the blood and bone marrow. In AML, the bone marrow makes many unformed cells called blasts. Blasts normally develop into white blood cells that fight infection. However, the blasts are abnormal in AML. They do not develop and cannot fight infections. The bone marrow may also make abnormal red blood cells and platelets. The number of abnormal cells (or leukemia cells) grows quickly. They crowd out the normal red blood cells, white blood cells and platelets the body needs. About 13,290 Americans are expected to be diagnosed with acute myelogenous leukemia (AML) in 2008. The chance of getting AML increases with age. However, children and adults of any age can develop AML. About one in five children with leukemia has AML. The goal of treatment for AML is to bring about a remission or to cure the disease. The number of patients with AML who enter remission, stay in remission for years or are cured has increased significantly over the past 30 years.

Causes and Risk Factors

AML starts with a change to a single cell in the bone marrow. With AML, the leukemic cells are often referred to as blast cells. Medical researchers are working to understand the cell changes that lead to AML. Some other risk factors associated with AML are:
* Some types of chemotherapy
* Radiation therapy used to treat other cancers
* Tobacco smoke
* Exposure to large amounts of benzene

Most people who have these risk factors do not get AML - and most people with AML do not have these risk factors. You cannot catch AML from someone else. Very rarely, more cases of AML than would be expected are diagnosed within the same family. It is thought that children in these families inherit a gene that makes them more susceptible to developing AML. Research to improve the understanding of familial cancers and effective medical management of them is underway.

Anyone can get leukemia. Leukemia affects all ages and sexes. The cause of leukemia is not known. Chronic exposure to benzene in the workplace and exposure to extraordinary doses of irradiation can be causes of the disease, although neither explains most cases.

 

Treatment
Patients with AML need to start chemotherapy right away. It is important to get medical care in a center where doctors are experienced in treating AML patients.

There are two parts of AML treatment, called induction therapy and consolidation therapy. The aim of induction therapy is to kill as many AML cells as possible and get blood cell counts back to normal over time. When the aim of induction therapy is achieved it is called a remission. A patient in remission feels better over time and leukemia cells can't be seen in his or her blood or marrow.

Induction therapy is done in the hospital. Patients are often in the hospital for three to four weeks. Some patients may need to be in the hospital longer.

Many different drugs are used to kill leukemic cells. Each drug type works in a different way to kill the cells. Combining drug types can strengthen the effects of the drugs. New drug combinations are being studied. Two or more chemotherapies are usually used together to treat AML. Some drugs are given by mouth. Most chemotherapies are given through a catheter placed into a vein, usually in the patient's upper chest.

The first round of chemotherapy usually does not get rid of all the AML cells. Most patients will need more treatment. Usually the same drugs are used for more rounds of treatment to complete induction therapy. More treatment is usually needed even after a patient with AML is in remission. This second part of treatment is called consolidation therapy. It is needed because some AML cells remain that are not found by common blood or marrow tests. Consolidation therapy is also done in the hospital. As with induction therarpy, patients may be in the hospital for three to four weeks, or sometimes longer. Consolidation therapy may include chemotherapy with or without an allogeneic stem cell transplant or autologous stem cell transplant.

 

Survival
The five-year relative survival rate has nearly quadrupled in the past 48 years for patients with leukemia. From 1960 to 1963, the five-year relative survival rate among Americans of European descent with leukemia was 14 percent.  From 1975 to 1977, the five-year relative survival rate for all persons with leukemia jumped to 35 percent, and from 1999 to 2005 the overall relative survival rate was 54 percent. The relative survival rates differ by the person's age at diagnosis, gender, race and the type of leukemia.

From 1999 to 2005, the five-year relative survival rates overall** were:

  • Acute lymphocytic leukemia (ALL): 66.3 percent overall; 90.9 percent for children under 5
  • Chronic lymphocytic leukemia (CLL): 78.8 percent
  • Acute myelogenous leukemia (AML): 23.4 percent overall; 60.2 percent for children under 15
  • Chronic myelogenous leukemia (CML): 53.3 percent

Currently, there are approximately 245,225 people living with leukemia in the United States.

** Treatment outcomes vary, even among patients with the same diagnosis. Individuals are encouraged to talk to their physicians for more information.  In addition, these statistics may underestimate survival to a degree because they may be based on data that does not include outcomes of treatment with the most current options available. Newer agents and drug combinations, progress in stem cell transplantation, better supportive care and studies of new drugs in clinical trials are all contributing to improved outcomes and quality of life for people diagnosed with blood cancers.

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