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Acute myeloid leukemia, also known as AML, is a type of cancer that affects blood cells and begins in the bone marrow, which is the organ responsible for the production of blood cells. This type of cancer has a greater chance of cure when it is diagnosed in its initial stage, when there is still no metastasis and causes symptoms such as weight loss and swelling of the tongues and belly, for example.
Acute myeloid leukemia proliferates very quickly and can happen in people of all ages, however it is more frequent in adults, as cancer cells accumulate in the bone marrow and are released into the bloodstream, where they are sent to other organs. , such as liver, spleen or central nervous system, where they continue to grow and develop.
The treatment of acute myeloid leukemia can be done in the cancer hospital and it is very intense in the first 2 months, and at least 1 more year of treatment is necessary for the disease to be cured.
Main symptoms
The most common symptoms of acute myeloid leukemia include:
- Anemia, which is characterized by a decrease in the amount of hemoglobin;
- Feeling of weakness and general malaise;
- Pallor and headache that are caused by anemia;
- Frequent bleeding characterized by easy nasal bleeding and increased menstruation;
- Occurrence of large bruises even in small strokes;
- Loss of appetite and weight loss without apparent cause;
- Swollen and painful tongues, especially in the neck and groin;
- Frequent infections;
- Pain in bones and joints;
- Fever;
- Shortness of breath and cough;
- Exaggerated night sweat, which gets to wet clothes;
- Abdominal discomfort caused by swelling of the liver and spleen.
Acute myeloid leukemia is a type of blood cancer that most commonly affects adults, and its diagnosis can be made after blood tests, lumbar puncture and bone marrow biopsy.
Diagnosis and classification
The diagnosis of acute myeloid leukemia is based on the symptoms presented by the person and the results of tests, such as blood count, bone marrow analysis and molecular and immunohistochemical tests. Through the blood count, it is possible to observe a decrease in the amount of white blood cells, the presence of circulating immature white blood cells and a lower amount of red blood cells and platelets. To confirm the diagnosis, it is important that the myelogram is performed, in which it is made from the puncture and collection of a bone marrow sample, which is analyzed in the laboratory. Understand how the myelogram is made.
To identify the type of acute myeloid leukemia, it is important that molecular and immunohistochemical tests are performed to identify characteristics of the cells found in the blood that are characteristic of the disease, this information being important to determine the prognosis of the disease and for the doctor to indicate the most appropriate treatment.
Once the type of AML is identified, the doctor can determine the prognosis and establish the chances of a cure. AML can be classified into some subtypes, which are:
Types of myeloid leukemia | Prognosis of the disease |
M0 - Undifferentiated leukemia | Too bad |
M1 - Acute myeloid leukemia without differentiation | Medium |
M2 - Acute myeloid leukemia with differentiation | Good |
M3 - Promyelocytic leukemia | Medium |
M4 - Myelomonocytic leukemia | Good |
M5 - Monocytic leukemia | Medium |
M6 - Erythroleukemia | Too bad |
M7 - Megakaryocytic leukemia | Too bad |
How the treatment is done
Treatment for acute myeloid leukemia (AML) needs to be indicated by an oncologist or hematologist and can be performed through several techniques, such as chemotherapy, medications or bone marrow transplantation:
1. Chemotherapy
Treatment for acute myeloid leukemia begins with a type of chemotherapy called induction, which aims at remission of the cancer, this means reducing the diseased cells until they are not detected in the blood tests or in the myelogram, which is the examination of the collected blood directly from the bone marrow.
This type of treatment is indicated by the hematologist, is performed in an outpatient clinic of a hospital and is carried out through the application of medications directly into the vein, through a catheter placed on the right side of the chest called a port-a-cath or by a access in a vein of the arm.
In most cases of acute myeloid leukemia, the doctor recommends that the person receives a set of various medications, called protocols, which are mainly based on the use of medicines such as cytarabine and idarubicin, for example. These protocols are done in phases, with days of intense treatment and a few days of rest, which allow the person's body to recover, and the number of times to be done depends on the severity of AML.
Some of the most common medications to treat this type of leukemia can be:
Cladribine | Etoposid | Decitabine |
Cytarabine | Azacitidine | Mitoxantrone |
Daunorubicin | Thioguanine | Idarubicin |
Fludarabine | Hydroxyurea | Methotrexate |
The doctor may also recommend the use of corticosteroids, such as prednisone or dexamethasone, as part of the treatment protocol for acute myeloid leukemia. Some research is being developed so that new drugs such as capecitabine, lomustine and guadecitabine are also used to treat this disease.
In addition, after remission of the disease with chemotherapy, the doctor can indicate new types of treatment, called consolidation, which serves to ensure that the cancer cells have all been eliminated from the body. This consolidation can be done through high-dose chemotherapy and bone marrow transplantation.
Treatment for acute myeloid leukemia with chemotherapy reduces the amount of white blood cells in the blood, which are the body's defense cells, and the person has low immunity, making them more susceptible to infections. Therefore, in some cases, the person must be admitted to a hospital during treatment and must use antibiotics, antivirals and antifungals to prevent infections from arising. And yet, it is common for other symptoms to appear, such as hair loss, swelling of the body and skin with spots. Learn about other side effects of chemotherapy.
2. Radiotherapy
Radiotherapy is a type of treatment that uses a machine that emits radiation into the body to kill cancer cells, however, this treatment is not widely used for acute myeloid leukemia and is only applied in cases where the disease has spread to other organs , such as the brain and testis, to be used before bone marrow transplantation or to relieve pain in a bone area invaded by leukemia.
Before starting the radiotherapy sessions, the doctor makes a plan, checking images of the computed tomography so that the exact location in which the radiation must be reached in the body is defined and then markings are made on the skin, with a specific pen, to indicate the right position on the radiotherapy machine and so that all sessions are always in the marked location.
Like chemotherapy, this type of treatment can also result in side effects, such as tiredness, loss of appetite, nausea, sore throat and skin changes similar to sunburn. Learn more about the care that should be taken during radiation therapy.
3. Bone marrow transplantation
Bone marrow transplantation is a type of blood transfusion made from hematopoietic stem cells taken directly from the bone marrow of a compatible donor, either through a blood aspiration surgery from the hip or through apheresis, which is a machine that separates the blood stem cells through a catheter in the vein.
This type of transplant is usually done after high doses of chemotherapy or radiotherapy drugs are performed and only after the cancer cells are not detected in the tests. There are several types of transplant, such as autologous and allogeneic, and the indication is made by the hematologist according to the characteristics of the person's acute myeloid leukemia. See more about how bone marrow transplantation is done and the different types.
4. Target therapy and immunotherapy
Targeted therapy is the type of treatment that uses drugs that attack cells sick with leukemia with specific genetic changes, causing fewer side effects than chemotherapy. Some of these medications used are:
- FLT3 inhibitors: indicated for people with acute myeloid leukemia with mutation in the geneFLT3 and some of these drugs are midostaurin and gilteritinib, not yet approved for use in Brazil;
- HDI inhibitors: recommended by the doctor for use in people with leukemia with mutated genesIDH1 orIDH2, that prevent the proper maturation of blood cells. HDI inhibitors, such as enasidenib and ivosidenib, can help leukemia cells mature to normal blood cells.
In addition, other drugs that act on specific genes are also being used as inhibitors of the BCL-2 gene, such as venetoclax, for example. However, other modern remedies based on helping the immune system fight leukemia cells, known as immunotherapy, are also highly recommended by hematologists.
Monoclonal antibodies are immunotherapy drugs created as proteins of the immune system that act by attaching themselves to the wall of AML cells and then destroying them. Gemtuzumab is a type of medicine that is highly recommended by doctors to treat this type of leukemia.
5. Car T-Cell gene therapy
Gene therapy using the Car T-Cell technique is a treatment option for people with acute myeloid leukemia that consists of removing cells from the immune system, 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 able to attack cancer cells.
After being treated in the laboratory, the T cells are replaced in the person with leukemia so that, modified, they destroy the cells sick with cancer. This type of treatment is still being studied and is not available by SUS. Check out more how Car T-Cell therapy is done and what can be treated.
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