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Acute Myeloid Leukaemia (AML)

Acute Myeloid Leukaemia (AML)
بالنسبة إلى أولئك الذين تم تشخيص إصابتهم بسرطان الدم النخاعي الحاد، يراودهم شعور كما لو أن جسدهم قد خانهم. قد تشعر بألم في العظام وقد تؤلمك معدتك وقد يتعذر عليك تناول الطعام. كما تُسهم بشرتك الشاحبة في ظهور الكدمات المتزايدة. ينتشر مرض الدم النادر هذا بسرعة ويمكن أن يتطور بالسرعة نفسها إذا لم يتم التعامل معه على الفور. ولكن على الرغم من الكيفية التي قد تظهر بها الأعراض عند تشخيص إصابتك لأول مرة، ثمة طرق لإبطاء تقدم هذه الحالة النادرة. وتتمثل أفضل طريقة للتعامل مع تشخيصك في أن تفهم أولاً ماهيته حتى تتمكن من اتخاذ قرارات بشأن العلاج المناسب لحالتك.
What is Acute Myeloid Leukaemia (AML)?

Acute Myeloid Leukaemia is a form of cancer that stems from a mutation of cells that reside in the bone marrow. Bone marrow creates young white blood cells, called myeloid cells, which grow into red and white blood cells or platelets. When these myeloid precursor cells have done their jobs, they are replaced by new cells. When you have AML, these myeloid cells replicate much faster than they should, taking up space in your body, and keeping healthy cells from bringing oxygen, fighting off infections, or healing injuries. These malignant cells can spread to other parts of the body, most commonly to the nervous system, liver, spleen or testicles, which can severely affect their ability to function.

There are several subtypes of AML, identified by a few factors, such as the number of healthy blood cells present, the size and number of these cells, and changes in DNA. Identifying a subtype can change your treatment plan and even your overall prognosis. For example, while nearly all AML subtypes are caused by DNA mutations, some mutations are more likely to lead to remission than others. Unlike other cancers, the progression of AML is not measured in stages.

What are the symptoms of Acute Myeloid Leukaemia (AML)?

AML is a fast-growing cancer, which means you will likely begin to feel some, or all, of these symptoms relatively quickly after the disease takes hold. The symptoms of AML are similar to other forms of leukaemia and may include:

  • Fatigue
  • Weakness
  • Fever
  • Infections
  • Bruising and bleeding easily and for abnormally long periods
  • Weight loss
  • Joint or bone pain
  • Shortness of breath
  • Swollen lymph nodes
  • Stomach-ache
  • Pale skin

There are several ways to test for AML, most commonly:

  • Blood samples to test for a complete count of the blood cells in your body. If you have AML, you will have low oxygen levels, an unusually high number of white blood cells, and your blood will likely have trouble clotting.
  • Bone marrow biopsies will test a small piece of the soft tissue inside your bone, looking for signs of cancer, testing the white blood cells found within for abnormalities, or examining the DNA within the bone marrow for signs of damage or mutation.
  • Imaging scans such as x-rays, CT scans, MRIs, or ultrasounds cannot be used alone to diagnose AML, but doctors will order these tests if they suspect AML has already reached vital organs or to help find the best areas to take a blood or bone marrow sample.

How common is Acute Myeloid Leukaemia (AML)?

While AML is the most commonly diagnosed form of leukaemia, it is still an extremely rare blood disease, accounting for just 1% of all cancers. Because of its rarity, it is difficult to pinpoint an exact number of current cases worldwide. That said, the World Health Organization estimated that in 2012 there were about 351,965 cases globally.9

Currently, it is impossible to detect AML before symptoms appear. However, there are common factors that can identify those who may be more likely to develop this disease, including:

  • Age: More common in those older than 65 years.
  • Gender: More common in men.
  • Smoking: More common among smokers.
  • Medical/Family History: Higher risk for those who have already been treated with chemotherapy for other forms of cancer or have a history of other blood or genetic disorders.
  • Exposure to dangerous elements: Higher risk if you have interacted with certain heavy metals, industrial chemicals, or radiation.

Treatment and Care

Treatment for AML will depend on your AML subtype, your age and health, family history, and any present infections or additional genetic mutations.10

Because this is a fast-moving disease, treatments need to be immediate and aggressive once the best path has been identified. Regardless of the treatment specifics, plans generally follow a two-step process:

  1. Remission Induction Therapy: The goal is to kill all of the malignant leukaemia cells in the bone marrow. When enough of these cells have been killed, and the level of unhealthy to healthy blood cells has shifted favourably, your AML is considered to be in remission.11
  2. Post-remission Therapy: The goal is to kill off any remaining unhealthy cells that may still persist and could cause a relapse.11

There are four common types of treatment:11

  1. Chemotherapy
  2. Radiation Therapy
  3. Chemotherapy with stem cell transplant
  4. Best Supportive Care

Caring for Someone with Acute Myeloid Leukaemia (AML)

A rare blood disease diagnosis can be an earth-shattering experience, and there is no doubt this will be a trying time for those with this disease. Because there is no way to see if you have AML until it is already present, coupled with its fast-acting nature, those with AML will likely feel as though their world has pulled out from under them.

As a loved one, it is important to offer strength and assistance wherever possible. Offer rides to chemotherapy treatments, encourage your loved one to eat when they do not have the appetite to do so. Maybe even put time into researching AML or looking for potential clinical trials.

In the time after diagnosis, those with AML will likely be thrust into an overwhelming sea of doctors, adding to the physical and emotional stress of not knowing what the future will hold. In those moments, when they are at the very tipping point, you can be the anchor that rights the ship. You can help them weather the storm at its worst and allow them to continue to sail on. As a loved one, you cannot make the fight for survival easier, but you can help make it less lonely.

Questions to Ask Your Doctor

The list below includes example questions to help start a conversation with your health care provider. There may be other relevant questions based on your symptoms, stage, and medical history that are not listed here.

  • What subtype of AML do I have?
  • What are my best treatment options?
  • What can I expect after my initial therapies?
  • What can I do to help improve my chances of remission?
  • How common is it to relapse after remission?
  • What side effects should I expect from the different treatment options?
  • What clinical trials are available to me and how do I apply?
  • What lifestyle changes can I make to help ease my symptoms and lower my chances of relapse?
  • How quickly do we need to begin treatment to offer the best chances of remission?
  • ….

Glossary

  • Myeloid cells: Young white blood cells that, when mutated, cause AML.
  • Platelets: A type of blood cell that helps injuries heal by creating scabs or bruises.
  • Lumbar Puncture: A procedure where doctors use a needle to collect spinal fluid.
  • Acute leukaemia: A type of leukaemia that progresses rapidly and appears suddenly.
  • Bone marrow: The soft tissue inside the bone.

المراجع

[1]
Memorial Sloan Kettering Cancer Center. Multiple Myeloma Symptoms. https://www.mskcc.org/cancer-care/types/multiple-myeloma/multiple-myeloma-symptoms. Last accessed April 2021.
[2]
American Cancer Society. Non-medical treatments for pain. https://www. cancer.org/treatment/treatments-and-side-effects/physical-side-effects/pain/ non-medical-treatments-for-cancer-pain.html. Last accessed Oct 2018.
[3]
Yong K, et al. Br J Haematol. 2016;175:252–264.
[4]
Snowden JA, et al. Br J Haematol. 2011;154:76–103.
[5]
Drugs.com. Multiple Myeloma. Available at: https://www.drugs.com/cg/multiple-myeloma.html. Last accessed April 2021.
[6]
Myeloma UK. Fatigue infoguide. Available at: www.myeloma.org.uk/wp-content/ uploads/2018/03/Myeloma-UK-Fatigue-Infoguide.pdf. Last accessed Aug 2018.
[7]
Multiple Myeloma Research Foundation website. Symptoms, side effects and complications. http://www.myeloma.org/sites/default/files/images/publications/UnderstandingPDF/concisereview.pdf. Last accessed April 2021.
[8]
Myeloma UK. Myeloma and the kidney infoguide. Available at: www.myeloma. org.uk/wp-content/uploads/2018/03/Myeloma-UK-Kidney-Infoguide.pdf. Last accessed Aug 2018.