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We all have cancer cells in our body and can fall prey to the disease any time in our lifetime. While some are born with cancer, others can develop it as they age or due to environmental and lifestyle factors. In other words, cancer can start anywhere in the body or at any time. The chance of survival or the prognosis factor comes into play after considering the patient’s genetics and other factors.
In adults, acute myeloid leukemia (AML) is a type of cancer in which the bone marrow makes abnormal myeloblasts – a type of white blood cell (WBC), red blood cells (RBCs), or platelets. This type of cancer progresses very quickly if it is not treated.
Given the fact that AML is fast growing, it is to be noted that the leukemia cells enter the blood quickly and can sometimes spread to the liver, spleen, central nervous system comprising the brain and spinal cord, and the testicles in men.
AML usually afflicts older adults and is also known by other names depending on the type of blood cell – myeloid or lymphocytic – it affects. The other names for AML include acute myelocytic leukemia, acute myelogenous leukemia, acute granulocytic leukemia, or acute non-lymphocytic leukemia.
Surviving leukemia is one of the foremost thoughts of a patient diagnosed with the blood cancer, as well as the caregiving family. Knowing how to reassure patients is at the top of the minds of expert oncologists at Fortis Hospitals Bannerghatta and they do this with panache, because they know exactly how a patient and the family feel. Giving hope and extending their support is one of the foremost things they offer leukemia patients along with the high precision treatment methodology specifically customised for each individual patient.
While a diagnosis by a doctor is the process of identifying the underlying cancer through the symptoms presented, a prognosis is the medical expert’s estimate of how the leukemia will affect a patient and how the cancer will respond to the different treatment methods. Both, prognostic and predictive factors are commonly discussed together by the team of oncologists to help them in the decision-making process of chalking out a precise treatment plan and the following prognosis based on this.
In children and younger adults especially those below 60, the prognosis is favourable given the fact that age is on their side. Older adults rarely have a good prognosis due to the fact that older adults are susceptible to other health conditions that make it difficult for them to fight the cancer and to cope with the side effects that accompany treatment for AML. Also, chromosomal defects can take place in older adults.
During the complete blood count tests, if the diagnosis of the white blood cells or WBCs are found to be more than the normal 100,000, the prognosis is less favourable.<br>
Since several changes or defects in the patient’s chromosomes are due to genetic factors causing the AML, they are used by the medical experts as markers or prognostic factors. A thorough study of all the genetic factors is undertaken to make the prognosis or prediction of leukemia survival post treatment.
Doctors categorise these chromosomal changes into good or poor risk groups. For patients with normal chromosomes or chromosomal changes that do not fall into the good or poor risk categories, doctors consider them as intermediate risk. The prognosis in these cases is between good and poor.
In some patients with AML, gene mutations take place and these are used as prognostic factors by onco experts.
Prognosis in patients who respond well to chemotherapy and the cancer goes into complete remission within four weeks of starting the medications, is considered favourable. Similarly, when the patient takes longer to reach complete remission, the prognosis is less favourable. The prognosis is poorer in people who don’t reach a complete remission after chemotherapy. When the leukemia returns in the AML patient soon after chemotherapy, it is called early relapse and the prognosis is less favourable.
Also, if the AML patient is affected with a serious, uncontrolled infection at the time of diagnosis, the prognosis is less favourable.
The prognosis is poor is if the AML spreads to the central nervous system affecting the brain and spinal cord.
Just like in all other illnesses and diseases, AML cannot be diagnosed through common symptoms such as unexplained weight loss, fever or flu-like infection, fatigue, loss of appetite and night sweats.
Persistent signs of all these coupled with other symptoms can show up more during a blood test prescribed by doctors to ascertain the causes. A complete blood count is one of the first tests that can reveal a lot more going on in your blood stream and the rest of the body.
The red blood cells or RBCs transport vital life-giving oxygen to the other cells in our body. A low RBC count can trigger suspicious reasons causing the condition which can in turn lead to other symptoms such as weakness and fatigue, dizziness, headaches, shortness of breath after minimal exertion, and feeling extreme cold in normal weather. Since several signs of AML are a result of a shortage of normal blood cells, this can show up in a blood test.
Frequent fevers due to persistent infections that do not go away soon portend there is something wrong with your immunity. When there is a low WBC count, it can raise the red flag on a serious health condition. Infections afflict your body when there is a shortage of normal WBCs or normal neutrophils which fight bacterial infections.
While those having AML have high white blood cell counts due to excess numbers of leukemia cells, these cells don’t protect against infection the way normal WBCs can protect you.
The important role of platelets in our blood is to stop bleeding but making the blood thicker. However, in those suffering from AML, the affected WBCs are bigger than normal cells and find it difficult to move through tiny blood vessels. When such defective WBCs multiply into large deposits, they can block the blood vessels and hence prevent the healthy red cells containing oxygen to reach the tissues. When blood vessels in the lungs are affected, you can have shortness of breath. Blood vessels in the eye can be affected as well, leading to blurry vision or even loss of vision.
A huge build-up of leukemia cells in the joints and bones can cause extreme pain and discomfort in the various joints and bones in your body.
Patients with a certain type of AML called acute promyelocytic leukemia (APL) might go to the doctor with problems with bleeding and clotting. They may have a nose bleed that won’t stop, or a cut that won’t stop oozing. They may also have calf swelling from a blood clot called a deep venous thrombosis (DVT) or chest pain and shortness of breath from a blood clot in the lung (called a pulmonary embolism or PE).
In some cases, leukemia cells can accumulate in the liver and spleen causing them to swell up or look full. Leukemia cells may collect in the liver and spleen, causing them to enlarge.
Leukemia cells can spread to the skin, gums, brain and spinal cord.
When these cancer cells spread to the skin, they cause red spots or rashes. In the gums, they can cause swelling and extreme bleeding that does not stop.
When the leukemia spreads to the brain and spinal cord it can cause symptoms such as blurred vision, headaches, weakness, problems with one’s balance, facial numbness, vomiting and seizures.
Rarely, AML can affect the lymph nodes in our neck, groin, armpits or the region above our collar bone causing them to enlarge.
Acute Myeloid Leukemia (AML) is a serious cancerous disease in adults, but is also treatable. With diagnosis at the right time to nip it in the bud, coupled with chemotherapy, AML is curable with or even without stem cell transplant.
AML is a quickly progressing cancer. But with the right diagnosis and fast line of multi-pronged treatment, it can be arrested before its spread.
Given the complex nature of its structure, the treatment of AML requires and thus involves the best of a multi-disciplinary team of cancer experts at Fortis Hospitals Bannerghatta to treat this deadly cancer. This team ensures the treatment begins as quickly from the time of the diagnosis.
The treatment process involves a dual effective plan that includes Induction and Consolidation.
This is the initial stage of AML treatment which aims to destroy as many leukemia cells in your blood and bone marrow to the best possible extent. This is done to restore the working of your blood circulation and treat the other accompanying symptoms if any.
As the name suggests, this stage of treatment is a kind of support backing the induction stage. Here, the aim is to prevent the relapse of or the return of the cancerous cells by eliminating the remaining leukemia cells that may exist in your body.
In a few cases, the induction stage of treatment may not be fully successful in killing all the leukemia cells and hence needs the consolidation process as a strong back-up.
Both the re-induction and follow-up consolidation treatment plans are the best attack mechanisms in the eventuality of a relapse.
The intensity of the dosage for chemotherapy can depend on your age and your ability to handle intensive chemotherapy.
In intensive chemotherapy, this aggressive line of treatment involves high doses of chemotherapy to destroy the fast-growing leukemia cells in your blood and bone marrow. In order to replenish your stock of healthy blood cells which could have been damaged by the leukemia, you will have regular blood transfusions.
The treatment will be conducted in highly sterile environs within a dedicated department to prevent you from catching infections. At this stage of leukemia, it is common for patients to be susceptible to various infections. Patients are monitored closely and treated with antibiotic regimen to prevent any combination of infections.
During treatment, the chemotherapy medications will be injected into a thin tube inserted either into a blood vessel near your heart or into your arm.
Non-intensive chemotherapy involves the use of alternative modes of treatment designed to control leukemia rather than cure it. This standard line of treatment is used by medical experts if they feel you are weak or cannot handle the strong effects of intensive chemotherapy.
Radiation therapy or radiotherapy involves using high doses of controlled radiation to eliminate the cancerous cells. This kind of treatment is usually administered by oncology specialists to prepare patients for stem cell or bone marrow transplants.
This is a revolutionary, life-changing cancer treatment process that has given a new lease of life to cancer patients. New healthy bone marrow cells are transferred into the patient’s blood vessel to replace the destroyed leukemia cells and initiate the process of cells production in the bone marrow.
Before the transplantation procedure, the patient is given intensive high-dose chemotherapy and possibly radiotherapy to destroy all the leukemia cells in their bone marrow.
The essence of a successful transplant depends on the age and health of the patient. It has been observed that transplant procedures are most successful in children, young patients or those older patients who are in sound health without underlying health conditions, and also when the donors are from the same family as the patient.
Bannerghatta Road, Cunningham Road, Richmond Road
Senior Director - Medical Oncology and Hemato-Oncology
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