Acute nonlymphocytic leukemia, often referred to as ANLL, is more commonly known as acute myeloid leukemia (AML). This is a rapidly advancing disease characterized by an excess of immature blood-forming cells in the bloodstream. These cells are specifically those that would typically develop into granulocytes or monocytes, both of which are white blood cell types that combat infections. In AML, these cells fail to mature properly, leading to an overabundance. AML can affect both adults and children. Initial symptoms of AML can mimic those of the flu or other common illnesses, with signs such as fever, weakness, fatigue, weight loss, appetite loss, and bone or joint discomfort. Additional symptoms might include small red skin spots, easy bruising and bleeding, frequent mild infections, and slow healing of minor wounds. To diagnose AML, blood tests are conducted to measure the levels of various blood cells and determine if they fall within normal ranges. In AML cases, red blood cell counts may be low, leading to anemia; platelet counts might be low, causing bleeding and bruising; and white blood cell counts may also be low, increasing infection risk.If blood tests reveal abnormalities, a bone marrow biopsy or aspiration may be performed. During a bone marrow biopsy, a hollow needle extracts a small sample of bone marrow and bone from the hip for microscopic examination. In a bone marrow aspiration, a small amount of liquid bone marrow is removed with a syringe. A lumbar puncture, or spinal tap, might be conducted to check if the disease has spread to the central nervous system (CNS), which includes the brain and spinal cord.Other important diagnostic tests include flow cytometry, immunohistochemistry, cytogenetics, and molecular genetic studies. The primary treatment for AML is chemotherapy, although bone marrow transplantation is becoming increasingly common and is being explored in clinical trials. Treatment for AML occurs in two phases. The first phase, induction therapy, aims to destroy as many leukemia cells as possible and achieve remission, where no signs of the disease are present, and blood counts normalize. This phase often includes a combination of drugs such as daunorubicin, idarubicin, or mitoxantrone, alongside cytarabine and thioguanine. Once remission is achieved, the second phase, post-remission therapy, begins. This phase is designed to eliminate any remaining leukemic cells, often involving high-dose chemotherapy with drugs like cytarabine, daunorubicin, idarubicin, etoposide, cyclophosphamide, and mitoxantrone.AML is categorized into several subtypes using the French American British (FAB) classification system, which groups subtypes based on the specific cell line where the disease originated. There are eight AML types, labeled M0 through M7. M2 and M4 represent 25% of cases each, M1 accounts for 15%, and both M3 and M5 account for 10%. Other subtypes are less common. AML is also classified by chromosomal abnormalities in the cancerous cells.The treatment approach for acute promyelocytic leukemia (APL), identified as M3 in the FAB system, differs from other AML forms. Most APL patients initially receive all-trans retinoic acid (ATRA), which results in a complete response in 70% of cases and improves survival rates. Subsequently, APL patients undergo chemotherapy, often including cytosine arabinoside (Ara-C) and idarubicin.Bone marrow transplantation involves replacing a patient's bone marrow with healthy marrow. Initially, the patient's bone marrow is eradicated using high-dose chemotherapy, with or without radiation therapy. Healthy marrow from a donor, who may be a perfect match or closely related, is transplanted into the patient via a vein. This procedure is known as an allogeneic bone marrow transplant when the donor is a relative or an unrelated person. A higher chance of recovery is anticipated if the procedure is performed at a hospital conducting more than five bone marrow transplants annually.The long-term prognosis for recovery depends on the AML subtype, as well as the patient's age and overall health.
