Acute Promyelocytic (M3) Leukemia (AML)
The early recognition and treatment of the acute promyelocytic leukemia (APL) subtype of AML is important because patients with APL may develop serious blood-clotting or bleeding problems. This can usually be prevented or treated by giving patients an anticoagulant (blood-thinner). Other treatments might include transfusions of platelets or other blood products. With modern therapies, bleeding is often less of a problem once treatment of APL begins.
The treatment of APL differs from usual AML treatment because a non-chemotherapy drug, all-trans retinoic acid (ATRA), a relative of vitamin A, is also used. Although remission induction is usually possible with ATRA alone, combining ATRA with chemotherapy with an anthracycline (daunorubicin, idarubicin) produces the best results.
Another drug, arsenic trioxide, has been effective in treating patients with APL whose leukemia comes back after the first treatment. Now doctors are studying whether arsenic trioxide should be added along with ATRA and chemotherapy as the first treatment. The major side effect of this drug is damage to the electrical conducting system of the heart. Electrocardiograms are used to monitor this.
Treatment with ATRA and the same chemotherapy drugs used for other subtypes of AML usually induces remission. The side effects of this treatment differ from those of standard AML induction chemotherapy, however, because retinoic acid syndrome may occur due to the use of ATRA. This potentially fatal syndrome can involve breathing problems due to lung fluid buildup, low blood pressure, kidney damage, and severe fluid retention.
Consolidation therapy usually consists of 2 or more courses of chemotherapy, usually with an anthracycline. This is followed by maintenance therapy with ATRA for at least one year. Some doctors will also recommend adding low doses of chemotherapy for one year. The drug used is a pill called 6-mercaptopurine (6-MP).
About 70-90% of patients are cured with this treatment.
sounds like you are very worried so here is a few things to help you understand.
AML is more common among men than among women.
AML can be kept in remission for a long time or cured in some adults. Depending on certain specific features of the leukemic cells, some patients with AML can be predicted to have a better or worse outlook. A patient's age and general health can also influence the prognosis.
Overall, the 5-year survival rate in adults under 65 is about 33%. It is 4% in people over 65. The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Many of these patients live much longer than 5 years after diagnosis, and 5-year rates are used to produce a standard way of discussing prognosis. Five-year relative survival rates do not include patients dying of other diseases and are considered to be a more accurate way to describe the prognosis for patients with a particular type and stage of cancer. Of course, 5-year survival rates are based on patients diagnosed and initially treated more than 5 years ago. They may no longer be accurate. Improvements in treatment result in a more favorable outlook for recently diagnosed patients.
Acute myeloid leukemia (AML), also known as acute myelocytic leukemia or acute myelogenous leukemia, is a cancer that begins in cells that normally develop into blood cells. "Acute" means that the leukemia develops quickly, and if not treated, would probably be fatal in a few months. Most cases of AML develop from cells that would turn into white blood cells, but some cases of AML develop in other types of blood-forming cells, except in lymphocytes. Acute leukemia that develops in lymphocytes is called acute lymphocytic leukemia and is discussed in a separate document.
AML starts in the bone marrow (the soft inner part of the bones), but in most cases it quickly moves into the blood. It can sometimes spread to other parts of the body including the lymph nodes, liver, spleen, central nervous system (brain and spinal cord), and testes.
Other types of cancer can start in these organs and then spread to the bone marrow. But these cancers that start elsewhere and then spread to the bone marrow are not leukemia.
Not all leukemias are the same. Leukemias are divided into 4 main types with several subtypes in order to better predict each patient's prognosis and help doctors select the best treatment for each patient.
Acute leukemia versus chronic leukemia: The first factor to consider in classifying a patient's leukemia is whether most of the abnormal cells are mature (resemble normal circulating white blood cells) or immature.
In acute leukemia, the bone marrow cells are unable to properly mature. Immature leukemic cells, which are often called blasts, continue to reproduce and accumulate. Without treatment, most patients with acute leukemia would live less than a few months. Some subtypes of acute leukemia respond well to treatment and many patients are cured, while other types of acute leukemia have a less favorable outlookIn chronic leukemia the cells can mature partly but not completely. They are not really normal. They generally do not fight infection as well as do normal white blood cells. And, of course, they survive longer, build up, and crowd out normal cells.
Myeloid leukemia versus lymphocytic leukemia: The second factor to consider in classifying leukemia is the type of bone marrow cells that are affected. If granulocytes or monocytes are involved, the leukemia is classified as myeloid leukemia (also known as myelogenous or myelocytic leukemia).
If the cancer develops from bone marrow lymphocytes, it is called lymphocytic (or lymphoblastic) leukemia. (Malignant lymphomas are also cancers of lymphocytes. But, unlike lymphocytic leukemias which develop in the bone marrow, lymphomas develop from lymphocytes in lymph nodes or other organs.)
Four main types of leukemia: By considering whether they are acute or chronic, and whether they are myeloid or lymphocytic, leukemias can be divided into 1 of 4 main types:
acute myeloid leukemia (AML)
chronic myeloid leukemia (CML) or chronic myelogenous leukemia
acute lymphocytic leukemia (ALL) or acute lymphoblastic leukemia
chronic lymphocytic leukemia (CLL)
Acute myeloid leukemia can cause many different signs and symptoms. Most of these occur in all kinds of AML, but some are particularly common with certain subtypes.
Patients with AML often have several generalized symptoms. These can include weight loss, unusual fatigue, fever, and loss of appetite. Of course, these are not specific to AML and are more often caused by something other than cancer.
Most signs and symptoms of AML result from a shortage of normal blood cells due to crowding out of normal blood cell-producing bone marrow by the leukemia cells. As a result, people do not have enough properly functioning red blood cells, white blood cells, and blood platelets.
Anemia, a shortage of red blood cells, causes shortness of breath, excessive tiredness, and a pale color to the skin.
A shortage of normal white blood cells (leukopenia), and, in particular, too few mature granulocytes (called neutropenia or granulocytopenia), increases the risk of infections. Although leukemia is often a cancer of white blood cells and patients with leukemia may have very high white blood cell counts (leukocytosis), the abnormal leukemia cells do not protect against infection.
Thrombocytopenia (not having enough platelets needed for plugging holes in damaged blood vessels) can lead to excessive bruising, bleeding, frequent or severe nosebleeds, and bleeding from the gums.
When leukemia cells spread outside the bone marrow, it is called extramedullary spread. This may occur after AML has been diagnosed.. Less often, extramedullary spread may be the first sign of cancer in someone who has not yet been diagnosed with AML.
If leukemia cells spread to the skin, it can cause small pigmented (colored) spots that look like common rashes. A tumor-like collection of AML cells under the skin or other parts of the body is called a chloroma or granulocytic sarcoma.
Acute myeloid leukemia sometimes causes enlargement of the liver and spleen, two organs located on the right and left side respectively, of the abdomen. Enlargement of these organs would be noticed as a fullness, or even swelling, of the belly. These organs are usually covered by the lower ribs but when enlarged, they can be felt by the doctor examining the patient.
Acute myeloid leukemia may occasionally spread to lymph nodes. If the affected nodes are close to the surface of the body (lymph nodes on the sides of the neck, in the groin, underarm areas, above the collarbone, etc.), a person or the health care provider may notice the swelling.
Leukemia cells that spread into the brain and spinal cord (central nervous system, or CNS) can cause headache, weakness, seizures, vomiting, difficulty in maintaining balance, and blurred vision. This is not common in patients with AML.
Some patients have bone pain or joint pain caused by the spread of leukemic cells to the surface of the bone or into the joint from the marrow cavity. Other uncommon sites of extramedullary spread include the testicles, ovaries, kidneys, or tissues around the eyes.
A particular subtype of AML known as the M5 or monocytic form (described in the section "How Is Acute Myeloid Leukemia Classified?") may spread to the gums, causing swelling, pain, and bleeding.
The testing usually takes about 3 weeks, because the leukemic cells must grow in laboratory dishes for a couple of weeks before their chromosomes are ready to be viewed under the microscope. The results of cytogenetic testing are written in a shorthand form that describes which chromosome changes are present.
A translocation, written as t(1;2), for example, means a part of chromosome 1 is now located on chromosome 2 and vice versa.
An inversion, written as inv(16), for example, means that part of the chromosome 16 is upside down and is now in reverse order but is still attached to the chromosome it originated from.
A deletion, written as del(7) or -7, for example, indicates part of chromosome 7 has been lost.
An addition, +8, for example, means that all or part of chromosome 8 has been duplicated, and too many copies of it are found within the cell.
Molecular genetic studies: Special tests of leukemia cell DNA can also find most translocations that are visible under a microscope in cytogenetic tests, as well as some translocations too small to be seen with usual cytogenetic testing under a microscope.
This sophisticated testing, called FISH (fluorescent in situ hybridization), is helpful in classifying leukemia because many subtypes of AML have distinctive translocations. Information about these translocations may be useful in predicting how the patient will respond to treatment.
These tests may also be used after treatment to find small numbers of leukemia cells that can be missed under a microscope.
Gene-expression profiling: This is a new experimental technique that is being used for many cancers. It produces a pattern of the genes that are in the cancer cells. This creates a unique fingerprint that can distinguish different kinds of cancer cells. It is also being used to classify subtypes of AML into different risk categories. This will add to the information that comes from the standard molecular genetic studies that only look for specific genetic abnormalities.
Imaging Studies
Imaging studies are ways of producing pictures of the inside of the body. Because leukemia does not usually form visible tumors, imaging tests are of limited value. There are several imaging studies that might be done in people with AML, but they are done more often to look for infections or other problems, rather than for the leukemia itself.
X-rays: Routine chest x-rays may be done if a lung infection is suspected
Computed tomography (CT) scan: The CT scan is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, as does a conventional x-ray, a CT scanner takes many pictures of the part of your body being studied as it rotates around you. A computer then combines these pictures into an image of a slice of your body.
CT scans are helpful in looking at internal organs. They can spot abscesses (pockets of infection), enlarged organs, and any large accumulation of leukemia cells.
If you are having a CT of the abdomen, after a set of pictures is taken you may be asked to drink 1 or 2 pints of a radiocontrast agent, or dye. This helps outline the intestine so that certain areas are not mistaken for tumors. You may also receive an IV (intravenous) line through which the contrast dye is injected. This helps better outline structures in your body. A second set of pictures is then taken.
The injection can cause some flushing (feeling of warmth, especially in the face). Some people are allergic and get hives; rarely more serious reactions like trouble breathing and low blood pressure can occur. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays.
CT scans take longer than regular x-rays, and you need to lie still on a table while they are being done. The part of your body being examined is placed within the scanner, a doughnut-shaped machine that completely surrounds the table. The test is painless, but you may find it uncomfortable to hold still in certain positions for minutes at a time.
CT scans can also be used to guide a biopsy needle precisely into a suspected abnormality, such as an abscess. For this procedure, called a CT-guided needle biopsy, you remain on the CT scanning table while a radiologist moves a biopsy needle toward the location of the mass. CT scans are repeated until the doctors are confident that the needle is within the mass. A fine needle biopsy sample (tiny fragment of tissue) or a core needle biopsy sample (a thin cylinder of tissue about ½-inch long and less than 1/8-inch in diameter) is then removed and examined under a microscope.
Magnetic resonance imaging (MRI)scans: MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed by tissues in the body and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. Not only does this produce cross-sectional slices of the body like a CT scanner, it can also produce slices that are parallel with the length of your body. A contrast material might be injected just as with CT scans, but is used less often.
MRI scans are very helpful in looking at the brain and spinal cord.
MRI scans are a little more uncomfortable than CT scans. First, they take longer—often up to an hour. Also, you have to be placed inside a tube, which is confining and can upset people with claustrophobia. The machine also makes a thumping noise that you may find disturbing. Some places provide headphones with music to block this out.
Gallium scan and bone scan: For this procedure, the doctor injects a slightly radioactive chemical into the bloodstream that collects in areas of cancer or infection. This accumulation of radioactivity can then be viewed by a special camera. These tests are useful when a patient has bone pain that might be due to infection or cancer.
Ultrasound: This test uses sound waves to produce images of internal organs. The test can distinguish solid from fluid-filled masses. It can help to show whether the kidneys, liver, or spleen are enlarged.
This is an easy test. It uses no radiation, which is why it is often used to look at developing fetuses. For an ultrasound examination, you simply lie on a table, and a technician moves the transducer over the part of your body being examined. Usually the skin is first lubricated with a gel.