Acute myeloid leukemia (AML) is a type of bone marrow cancer that affects the production of blood cells such as white blood cells, red blood cells and platelets, resulting in symptoms such as nosebleeds, easy bruising, paleness or unintentional weight loss.
This type of cancer is very aggressive and proliferates very quickly, being the most common type of leukemia, mainly affecting adults over 65 years of age and children.
The treatment of acute myeloid leukemia is carried out by a hematological oncologist who may recommend chemotherapy, targeted therapy or bone marrow transplantation.
Symptoms of acute myeloid leukemia
The main symptoms of acute myeloid leukemia (AML) are:
- Frequent or severe nose or gum bleeding;
- Bruises or purple or red spots on the skin;
- Intense menstrual flow;
- Intense night sweats or paleness;
- Frequent infections;
- Headache, dizziness or vertigo;
- Loss of appetite and weight loss without apparent cause;
- Excessive tiredness, weakness or general malaise.
In addition, other symptoms are swollen and painful tongues, especially in the neck and groin, fever, pain in the bones and joints, shortness of breath, cough or abdominal discomfort caused by swelling of the liver and spleen.
The symptoms of AML arise due to a decrease in the number of circulating red blood cells, leukocytes and platelets, which happens due to changes in the functioning of the bone marrow, which produces and releases immature cells into the circulation.
It is important to consult a general practitioner or hematologist as soon as the first symptoms of leukemia appear, as this allows the diagnosis to be made and the most appropriate treatment to begin, with a greater chance of a cure.
How to confirm the diagnosis
The diagnosis of acute myeloid leukemia is made by an oncology hematologist or general practitioner through evaluation of symptoms, health history and laboratory tests.
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The main laboratory tests that may be ordered by the doctor are a complete blood count, in which a decrease in leukocytes, red blood cells and platelets in the blood can be seen, as well as the presence of blast cells, that is, immature myeloid cells in the bloodstream.
Furthermore, to confirm the diagnosis, the doctor must request a myelogram, which is performed by puncturing and collecting a sample of the bone marrow, which is analyzed in the laboratory. Understand how the myelogram is performed.
Other tests that the doctor may request are cytogenetics and molecular and immunohistochemical tests, to identify characteristics of the cells found in the blood, this information being important for determining the prognosis of the disease and for the doctor to indicate the most appropriate treatment.
Types of AML
AML can be classified into some subtypes according to the genetic alteration and, consequently, prognosis, the main ones being:
Once the type of AML is identified, the doctor can determine the prognosis and establish the chances of a cure.
Possible causes
The exact cause of acute myeloid leukemia is not yet completely known, but it is known that it occurs due to mutations in myeloid stem cells, which give rise to red blood cells, platelets and leukocytes.
Some factors can increase the risk of AML, such as:
- Age, being more common after 65 years of age or in children;
- Myelodysplastic syndrome;
- Aplastic anemia or myelofibrosis;
- Congenital diseases, such as Down syndrome or Bloom syndrome;
- Exposure to radiation, cigarettes or benzene;
- Chemotherapy or radiotherapy to treat other cancers.
Acute myeloid leukemia occurs due to a change in the functioning of the bone marrow, which becomes unable to make the cells produced mature.
These factors can cause mutations in genes such as FLT-3, c-KIT, RAS, RUNX1, RARa or BCR-ABL, for example, causing bone marrow cells to not mature normally or to multiply uncontrollably.
How the treatment is carried out
The treatment of acute myeloid leukemia (AML) must be carried out by a hematological oncologist and can be carried out through various techniques, such as chemotherapy, medications or bone marrow transplantation:
1. Chemotherapy
Chemotherapy for acute myeloid leukemia involves the use of cytotoxic drugs, such as cytarabine and idarubicin, for example, which help to destroy cancer cells and prevent the formation of new tumor cells.
Chemotherapy treatment is divided into two phases, which are:
- Induction chemotherapy: is the initial treatment that aims to eliminate leukemic cells and reduce the number of abnormal cells in the bone marrow, until they are no longer detected in blood tests or myelograms;
- Consolidation chemotherapy: It is done after the initial treatment to eliminate leukemic cells that may still be in the blood, and is done in cycles with days of intense treatment and a few days of rest.
In most cases of acute myeloid leukemia, the doctor recommends that the person receive a set of several chemotherapy drugs, and the use of corticosteroids, such as prednisone or dexamethasone, may also be part of the treatment.
Read too: How to alleviate the side effects of chemotherapy
2. Target therapy
Targeted therapy uses drugs to help the immune system identify and specifically attack acute myeloid leukemia cells, having little effect on the body’s normal cells.
Some drugs used in targeted therapy for the treatment of AML are midostaurin, gilteritinib, gentuzumab ozogamicin or venetoclax, for example, and the use varies according to the subtype of acute myeloid leukemia.
In some cases, targeted therapy can be combined with chemotherapy to increase the chance of cure.
3. Agents of differentiation
Differentiating agents, such as tretinoin in capsules or arsenic trioxide in the form of injection into the vein, may be recommended by the oncological hematologist for the treatment of acute myeloid leukemia type M3, or acute promyelocytic leukemia (APL).
These drugs are generally used together with induction chemotherapy and work by helping immature cells to differentiate, that is, to transform into normal leukocytes.
This is because during chemotherapy, when immature cells die, they can release proteins into the bloodstream and increase blood clotting, which can cause complications, and these medications prevent this from happening.
4. Radiotherapy
Radiotherapy is used to eliminate acute myeloid leukemia tumor cells.
However, this treatment is not widely used for AML and is only applied in cases where the disease has spread to other organs, such as the brain and testicle, to be used before marrow transplant or to relieve pain in a bone area. invaded by leukemia.
Read too: Radiotherapy: what it is, what it is for and side effects
5. Bone marrow transplant
Bone marrow transplantation is a treatment for acute myeloid leukemia, carried out with the transfusion of hematopoietic stem cells taken directly from the person’s own bone marrow or from a compatible donor.
Generally, this type of transplant is done after high doses of chemotherapy or radiotherapy and only after cancer cells are not detected in the tests. See more about how bone marrow transplants are performed and the different types.
6. Car T-Cell Gene Therapy
Gene therapy using the Car T-Cell technique is a treatment option for people with acute myeloid leukemia that involves removing immune system cells, known as T cells, from a person’s body and then sending them to the laboratory.
In the laboratory, these cells are modified and substances called CARs are introduced so that they are capable of attacking cancer cells.
After being treated in the laboratory, the T cells are replaced in the person with leukemia so that, when modified, they destroy the cancer cells. This type of treatment is still being studied and is not available through the SUS. Find out more about how Car T-Cell therapy is performed and what can be treated.
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