Acute Myeloid Leukemia (AML), also referred to as acute myelogenous leukemia, is a rapidly advancing condition characterized by an excessive number of immature blood-forming cells in the bloodstream. These cells are intended to develop into granulocytes or monocytes, types of white blood cells essential for combating infections. However, in AML, these cells fail to mature and multiply excessively. AML can affect both adults and children and is also known as acute non-lymphocytic leukemia (ANLL).Early symptoms of AML often resemble those of the flu or other common illnesses, presenting as fever, weakness, fatigue, weight loss, and loss of appetite, along with bone or joint pain. Additional signs may include small red spots on the skin, easy bruising and bleeding, frequent infections, and slow healing of minor wounds.Diagnosis begins with blood tests to determine the levels of various blood cells and assess whether they fall within normal ranges. In those with AML, red blood cell counts might be low, leading to anemia; platelet counts might be reduced, causing bleeding and bruising; and white blood cell counts might be low, resulting in infections.If blood test results are abnormal, a bone marrow biopsy or aspiration may be performed. This involves using a hollow needle to extract a small sample of bone marrow and bone from the hip for microscopic examination. In aspiration, a liquid bone marrow sample is drawn using a syringe.To check if leukemia has spread to the central nervous system (CNS), a lumbar puncture, or spinal tap, might be conducted. Additional diagnostic tests include flow cytometry, immunohistochemistry, cytogenetics, and molecular genetic studies to analyze cancer cells.The main treatment for AML is chemotherapy, though other therapies may be used in specific cases. Bone marrow transplantation is being increasingly explored through clinical trials.AML treatment consists of two phases. The first phase, known as induction therapy, aims to eradicate as many leukemia cells as possible and induce remission, where there is no visible disease, and blood counts are normal. This phase may involve a combination of drugs like daunorubicin, idarubicin, or mitoxantrone along with cytarabine and thioguanine. Once remission is achieved, patients proceed to the second phase of treatment.The second phase—post-remission or continuation therapy—targets any remaining leukemia cells. Patients may receive high-dose chemotherapy, which could include combinations of cytarabine, daunorubicin, idarubicin, etoposide, cyclophosphamide, and mitoxantrone.AML is classified into various subtypes using the French-American-British (FAB) system, based on the specific cell line affected. There are eight subtypes, labeled M0 to M7. Subtypes M2 and M4 account for 25% of cases each, M1 for 15%, and M3 and M5 each for 10%, while other subtypes are rare. Classification also considers chromosomal abnormalities in cancer cells.Treatment for acute promyelocytic leukemia (APL), subtype M3 in the FAB system, differs. APL patients typically receive all-trans retinoic acid (ATRA), resulting in a complete response in 70% of cases, followed by chemotherapy likely involving cytosine arabinoside (Ara-C) and idarubicin.Bone marrow transplantation involves replacing a patient's marrow with healthy donor marrow. The patient's existing marrow is destroyed with high-dose chemotherapy, sometimes combined with radiation therapy. The donor, ideally a close match, provides healthy marrow, which is administered through a vein. Transplants using related or unrelated donor marrow are called allogeneic transplants. Recovery chances improve if the procedure is performed at a hospital conducting more than five transplants annually.The prognosis for recovery depends on the AML subtype, as well as the patient's age and overall health.
