Acute myeloid leukemia. What is acute myeloblastic leukemia and what is life expectancy?

13.04.2019

Acute myeloid leukemia is a blood cancer. It is characterized by a large number of mutated cells.

In the case of leukemia in humans, these are leukocytes. The peculiarity of this disease is that diseased cells multiply very quickly and spread throughout the human body.

The problem is that acute myeloid leukemia is a childhood disease, as it occurs in children. Despite the problems and symptoms, timely and correct treatment methods can have a positive result.

How does acute myeloid leukemia manifest?

Myeloid leukemia is not secretive, but shows its symptoms. Therefore, detecting it in a person will not take much time.

The main reasons may be: high temperature, severe and constant fatigue, shortness of breath, frequent infectious diseases.

Leukemia is characterized by unhealthy white blood cells in a person's blood, and they appear because the bone marrow is unable to produce normal healthy cells to maintain the functionality of the body. Other manifestations of acute leukemia include:

excessive bleeding;
severe nausea and vomiting;
pain in bones or joints;
periodic headaches.

If you have some of the above symptoms, there is no reason to think that you have cancer. For a detailed examination, you must consult a doctor for advice.

With leukemia, the mucous membrane may be affected. Such lesions may be located in the mouth or in the esophagus. The patient has swelling in the gum area.

Most of the symptoms are not critical, so if some of them occur, you need to go to the hospital for a detailed examination and consultation.

The doctor will prescribe an examination, laboratory tests, and after a detailed study of the results obtained, he will tell you what to do next. An important point is that treatment cannot be carried out at home. The entire course of treatment must be carried out in a hospital.

Causes of leukemia

Leukemia is a cancerous disease, so the causes of oncology are not fully understood. Experts note that the main reason for the development of myeloid leukemia in humans is a strong dose of radioactive radiation and the effect of chemotherapeutic agents on the body.

This disease may be a consequence of treatment of a malignant tumor.

The spread and reproduction of mutated leukocytes occurs as follows. Due to external factors, abnormal cells begin to appear and collect in the bone marrow. Due to their large accumulation, the bone marrow stops creating new (healthy) cells; already created normal cells are gradually destroyed.

Mutated leukocytes begin to enter the body. This process is not that long, but it is gradual and will take some time. After which a person will have only diseased cells in the body.The harmful effects of mutated cells on the body do not end there.

With the help of the circulatory system, leukocytes spread throughout the body, penetrating directly into the organs. When mutated leukocytes enter human organs, they begin the process of division, which leads to the formation of small tumors under the skin.

In addition to small tumors, a clear sign of the penetration of diseased cells into organs can be the appearance of diseases such as meningitis, severe kidney failure, anemia, and damage to other organs.

Acute myeloid leukemia can be caused by radiation or chemotherapy. Medical practice is full of cases where the disease occurs due to the following reasons:

Manifestation of myelodysplastic syndrome.
Genetic abnormalities or pathologies (Fanconi anemia, Down syndrome, neurofibromatosis and others).
Poor ecology, contributing to the destruction of the body's immune system.
Predisposition to the disease (one of the first-degree relatives already had this disease).

The largest risk group is the elderly.

What are the symptoms of acute leukemia?

Acute myeloid leukemia can present with multiple signs and symptoms, and symptoms will vary from person to person.

The main symptom of leukemia in humans is anemia. This symptom includes shortness of breath, pale skin, poor appetite, and severe fatigue.

A person with leukemia may bleed (even with weak or shallow cuts). Unreasonable formation of bruises and severe hematomas with minor injuries.

With leukemia, a person is susceptible to infectious diseases that are difficult to treat. The reason is the absence of healthy and normal white blood cells.

In addition to bleeding and weakness of the body, the obvious cause of acute leukemia is damage to the mucous membranes of the mouth and gastrointestinal tract. Leukemia causes increased body temperature and severe bone pain.

All of these symptoms are common, so a diagnosis must be made before starting treatment. Laboratory tests must be carried out, and treatment must take place in a hospital.

How is leukemia diagnosed?

In order to diagnose a disease such as acute myeloid leukemia, complete hospitalization is necessary to undergo a full range of treatment. In the hospital, doctors will prescribe examination methods such as:

X-ray examination.
MRI.
The main method is to donate blood for a general analysis. This will let you know the quantitative indicator of healthy and diseased leukocytes in the human body. In addition, the doctor will be able to understand how certain organs function in conditions of illness.
The procedure is a bone marrow puncture. This method is based on obtaining tissue from bone marrow. This is done using a special needle, which is inserted into the femur. With its help, they take part of a sample of the material, and then examine it in the laboratory.
Carrying out an ultrasound examination.
Thanks to a chromosome test, the subtype of myeloid leukemia can be determined.
A spinal tap may also be performed. This is done to detect cancer cells in brain fluid.
Conducting a tissue typing test. It is carried out for a qualitative comparison of the patient’s antigen proteins, in case it is necessary to look for a bone marrow donor.

If, during an examination for the presence of acute leukemia, and the reaction to myeloperoxidase is more than 3% of blasts, then the result will be considered positive.

There are numerous factors that contribute to the risk of the disease. Some of them are listed below:

Elderly people are at risk. They tolerate the disease more difficult than children or middle-aged people.
There are many types of leukemia. Some of them (M0, M6, M7) are difficult to treat and may pose a risk to human health and life. Other types, such as M3, are treated and have a good prognosis for full recovery.
Doctors say that secondary leukemia, which appears from various hematological diseases, carries a high risk.

How to treat leukemia?

Leukemia is a serious disease that progresses rapidly; if timely treatment is not started, this will lead to consequences.

The peculiarity of the type of myeloid leukemia is that there are no intermediate stages in the disease. Leukemia may appear over time or remain in remission for a long time.

Modern medicine offers treatment for acute leukemia, which is based on a two-stage approach:

First stage called the induction phase. The main goal that doctors pursue at this stage is to remove abnormal cells from the body. If not complete, then a large amount. Thanks to this event, you can begin the remission stage.
Second phase called post-remission. When the second stage of treatment begins, the main goal of doctors is to maintain the effect of therapy and eliminate the effects of the disease.

Carrying out treatment for leukemia is a complex task for the doctor, the disease is unpredictable (like all cancers), each phase involves therapeutic methods.

Treatment methods for acute myeloid leukemia

Carrying out chemotherapy. Treatment is carried out using this method as standard. The patient is prescribed special chemotherapy drugs that are administered intravenously.
Partial or complete stem cell transplantation. This method is used only in severe cases of leukemia (often this happens in young children). The procedure can be carried out after chemotherapy has been completed and there are no more mutated stem cells left in the body. The main goal of stem cell transplantation is to completely or partially replace diseased cancer cells.
Maintenance therapy. This treatment is important for leukemia. The peculiarity of this (one might say the last) method of treatment is that the procedures performed do not require hospitalization of the patient. Doctors prescribe medications that can be taken at home.

Myeloid (myeloblastic) leukemia is one of the diseases that affects blood cells. Neoplasms affect not only the blood, but also other internal organs, disrupting the normal functioning of the body.

Distinctive features of the disease

Leukocytes in the human body fight infections, providing protection. With blood cancer, white cells mutate, degenerate, they begin to grow rapidly and cause disturbances in the functioning of the body. When a large number of improperly developed leukocytes accumulate in the blood, a disease such as leukemia develops.

This disease affects people of different sexes and different ages.

The disease has two forms:

acute;
chronic.

Unlike other cancers, where the acute form can progress to a chronic stage, forms of the myeloid type do not transform into each other. These are different diseases with their own characteristics.

Acute myeloid leukemia is characterized by excessive growth of immature, blast cells. The process of disease development is very rapid and requires timely treatment.

Acute leukemia has several stages:

Acute myeloid blood cancer is a disease that can develop at any age, but more often it is characteristic of the age group over 55 years. This is one of the most common forms. This disease ranks second, second only to acute lymphocytic leukemia. In children, acute myeloid leukemia accounts for almost 20%.

The chronic form of myeloid leukemia is characterized by excessive pathological growth of mature and maturing cells of the leukocyte series. The disease progresses very slowly and does not have pronounced symptoms in the first stages. Often the diagnosis is made by chance, during a laboratory blood test for another disease. Chronic leukemia, like acute, also has 3 stages:

Most often adults get sick, but it also occurs in children. Children account for about 2% of cases.

The group of chronic myeloid leukemias includes the chronic form of monocytic blood cancer, erythromyelosis, subleukemic myelosis, and other myeloid leukemias.

The subleukemic variant of chronic myeloid leukemia is most often observed in elderly patients. The disease is accompanied by the proliferation of connective tissue in the bone marrow, which ultimately leads to its replacement with scar connective tissue. A feature of the course of the disease is the absence of complaints for many years. As the disease develops, the patient may experience the following symptoms:

increase in the size of the spleen;
general weakness;
redness of the facial skin;
fast fatiguability;
frequent joint pain;
headaches.

Hemorrhagic syndrome occurs, which is caused by a violation of the ability of blood to clot.

Stage 1 is characterized by:

slight increase in the size of the spleen;
mild anemia;
increased platelet levels.

Stage 2 of the subleukemic variant of chronic myeloid leukemia, intermediate, is characterized by:

a significant increase in the size of the spleen;
mild anemia;
the presence of drop-shaped red blood cells in the patient’s blood;
absence of unfavorable factors.

Stage 3, advanced, is characterized by:

moderate anemia;
the presence of one or more unfavorable factors.

Most often, this disease is benign. Once the diagnosis is established, subject to correctly prescribed therapy, the patient’s life expectancy can reach 20-30 years. In the unfavorable case, when the disease develops rapidly, a sharp increase in the size of the spleen is observed, and the patient’s condition is aggravated by associated complications. The addition of secondary infections, severe degeneration, and hematopoietic insufficiency often cause death.

Causes of the disease

What causes myeloid leukemia does not currently exist. However, a number of reasons have been identified that significantly increase the risk of developing the disease.

Such causes may be genetic problems such as Down syndrome, neurofibromatosis. The disease, especially its acute form, is often observed in children who have undergone chemotherapy or radiation therapy for another diagnosis.

Leukemia: main symptoms

The symptoms of myeloid leukemia are similar to those of other types of leukemia. The acute form of the disease is characterized by its rapid manifestation. These include:

easily formed hematomas, frequent subcutaneous hemorrhages, bleeding gums;
elevated temperature;
night sweats;
pale skin;
severe shortness of breath when walking or light physical activity;
rapid weight loss;
fatigue;
frequent and severe joint pain;
cardiopalmus.

Chronic myeloid leukemia at the initial stage is asymptomatic. Only the result of a blood test can indicate the development of this pathology. Patients often complain of general malaise and heaviness after eating.

For the advanced stage, characteristic symptoms are:

prostration;
weight loss;
profuse sweating;
elevated temperature;
stomach upset;
increase in liver size.

Terminal stage, the following symptoms appear:

increase in the size of the spleen;
a sharp increase in temperatures;
hemorrhages under the skin;
weight loss;
lack of response to treatment.

Laboratory test results will give a clear picture of the disease.

A general blood test will reveal:

decreased red blood cell levels;
decreased reticulocyte levels;
leukocytes have strong fluctuations, from high to low levels;
platelet level is reduced;
absence of basophils and eosinophils in peripheral blood;
elevated ESR level.

Bone marrow analysis reflects:

more than 20% presence of myeloblastic cells;
decreased levels of other bone marrow growth cells.

Treatment of the disease

Treatment of chronic myeloid leukemia does not require hospitalization and can be carried out on an outpatient basis. Therapy is prescribed immediately after diagnosis. In the chronic phase, the main goal of therapy is to reduce the level of leukocytes.

Treatment of this disease is possible by:

stem cell transplants;
symptomatic therapy.

The first course of treatment involves chemotherapy, which allows you to destroy the cancer cells affected by the pathology. A course of chemotherapy does not guarantee a complete cure. Bone marrow transplantation allows us to talk about a complete recovery, but remission can last a fairly long period. Chemotherapy is the only treatment option if:

due to physical condition, radiation therapy is contraindicated;
the patient refuses to expose himself to high risk;
it is impossible to find a donor.

In addition to the affected cells, chemotherapy also destroys bone marrow cells. Donor cell transplantation is a very effective treatment method. Cells are selected and frozen. Once the transplant is successful, the cells begin to take root in the body. Next comes their maturation and development. From them, complete blood elements are obtained. There are 2 methods of cell transplantation: one of them uses donor cells, the other uses the patient’s own cells.

Important! Acute myeloid leukemia develops rapidly, so it is important to make a correct diagnosis in a timely manner and prescribe adequate treatment.

There are no intermediate stages for this type of disease. A distinction is made between a newly established diagnosis and a disease in remission.

Treatment consists of two phases:

induction phase: therapy is prescribed aimed at destroying as many affected cells as possible, which leads to remission;
The post-remission phase is aimed at maintaining a positive therapeutic effect.

As in the case of the chronic form, treatment of the myeloid type is carried out using the following methods:

chemotherapy;
a course of radiation therapy is prescribed;
symptomatic treatment is carried out;
stem cell transplant.

Prognosis for recovery

The prognosis of myeloid leukemia can be influenced by many factors. It may get worse when:

patient age over 60 years;
there is another cancer;
the presence of genetic mutations in cells;
very high white cell count at diagnosis;
the need for two or more courses of chemotherapy.

Attention! Successful treatment and favorable prognosis for myeloid leukemia are highly dependent on the person’s age.

Adults with acute myeloid leukemia have the following prognosis:

5-year survival rate for older people is 25% of cases;
for people over 45 years of age, survival rate is about 50% of cases, and in some cases there is a chance of complete relief from the disease;
for the age category over 65 years, survival rate at 5 years is 12%;
Younger patients have a better chance of making a full recovery.

The prognosis for chronic myeloid leukemia largely depends on the stage of the disease at the time of diagnosis. The patient’s body’s reaction to the course of treatment prescribed by the doctor plays a huge role. The 5-year life expectancy rate for chronic myeloid leukemia is on average 90%. Modern methods of biological therapy make it possible to achieve stable remission. If the above treatment methods do not have the desired effect, a stem cell transplant may be used. This procedure extends the life of patients to 10-15 years or more. An unfavorable prognosis may occur in cases of extremely late detection and diagnosis of the disease.

Myeloblastic leukemia is often classified as a disease of the young. According to statistics, it is most often detected in people who have barely crossed the threshold of 30-40 years. If we talk about the prevalence of pathology, then such a disease occurs in 1 case per 100 thousand population. There is no dependence on gender or race.

What is the essence of the problem?

In the picture you can see what the blood composition is in a healthy person, and how it changes with leukemia:

Many people are naturally concerned about the question: what is it? Acute myeloid leukemia (or acute myelocytic leukemia) is an oncological pathology affecting the blood system, when there is an uncontrolled proliferation of leukocytes of an altered shape. In addition, the blood test will also contain problems such as a decrease in the number of red blood cells, platelets and white blood cells from the normal category.

Blood diseases are particularly dangerous for humans. And this is not without reason, because it is the blood that is in close contact with all organs and systems in the body, it is the blood that carries vital hemoglobin and oxygen. Therefore, it is extremely important that blood circulation is fully and correctly established. The cellular composition should remain within normal limits.

Acute myeloid leukemia (AML) is a condition in which immature blood cells called blasts change. At the same time, there is a lack of mature cells in the body. The modified blasts increase virtually exponentially.

It is important to understand here that the process of cell change is irreversible and is not controlled by any medications. Blast cell leukemia is a serious and life-threatening disease.

Typically, all pathological processes in such a situation are localized in the bone marrow and peripheral circulatory system. Malignant cells actively suppress those that are not broken or spoiled and begin to infect literally everything in the body.

What is leukemia and can it be prevented? What is chemotherapy? Find out the answers to your questions by watching the following video:

Types of problem

Acute myeloid leukemia is a fairly wide group of pathological changes in the human body. Thus, there are several options when classifying this pathology:

M0 is a dangerous variety that is highly resistant to chemotherapy and has an extremely unfavorable prognosis for the patient’s life.
M1 is a rapidly progressive type of myeloblastic leukemia with a high content of blast cells in the blood.
M2 – the level of mature leukocytes is about 20%.
M3 (promyelocytic leukemia) - characterized by an active accumulation of immature leukocytes in the bone marrow.
M4 (myelomonocytic leukemia) – treated with chemotherapy and bone marrow transplant. It is more often diagnosed in children and has an unfavorable prognosis for life.
M5 (monoblastic leukemia) – about 25% of blast cells are detected in the bone marrow;
M6 (erythroid leukemia) is rare and has a poor prognosis.
M7 (megakaryoblastic leukemia) is a pathology with injury to the myeloid lineage that develops in Down syndrome;
M8 (basophilic leukemia) - diagnosed in children and adolescents. Together with myeloblastic cells, atypical basophils are detected.

A more detailed classification of leukemia is presented in the picture:

The choice of treatment tactics, life prognosis and the duration of remission intervals directly depend on the type of leukemia.

Reasons for the development of the problem

Leukemia, acute myeloid leukemia - all this is the same name for such a pathology. Naturally, many people are concerned about what leads to the development of such a problem. But, as is the case with other types of oncology, doctors cannot name the catalyst for changes in blood cells with 100% certainty. However, it is possible to identify predisposing factors.

Today, the main reason for the development of pathology is chromosomal abnormalities. Usually they mean the situation called the “Philadelphia chromosome”. This is a condition when, due to a disorder, entire sections of chromosomes begin to change places, forming a completely new structure of the DNA molecule. Then copies of such malignant cells are quickly formed, which leads to the spread of pathology.

According to doctors, this situation can be caused by:

Exposure to radiation. For example, those at risk are those who are in production areas with a large amount of radiation, rescuers working at the site of removing rubble, as was the case at the Chernobyl nuclear power plant, patients who have previously undergone irradiation for the treatment of another type of oncology.
Some viral diseases.
Electromagnetic radiation.
Impact of a number of drugs. Usually in this case they mean anti-cancer therapy due to its increased toxicity to the body.
Heredity.

Those who are at risk should be screened regularly.

Symptoms of pathology

AML in adults, as in children, is characterized by certain symptoms and signs. Cells multiply and change at an uncontrollable speed, so signs of the disease appear quite quickly, and a person cannot ignore them - they are too bright.

Symptoms of this pathology include:

Pale skin – this symptom is often called one of the first and most characteristic, because it accompanies all hematopoietic pathologies.
Signs of anemia.
Uncontrolled bleeding that is sometimes difficult to stop.
The appearance of low-grade fever - it can fluctuate between 37.1-38 degrees, the appearance of sweating during night sleep.
The appearance of a rash on the skin - it appears as small red spots that do not itch.
The appearance of shortness of breath - and it is typical even for small physical activities.
The appearance of a feeling of pain in the bones, especially intensified while walking, but the pain is not severe, so people can get used to it.
The appearance of swelling in the gums, the development of bleeding and gingivitis.
The appearance of hematomas - such red-blue spots can appear in any part of the body.
Decreased immunity and frequent infectious diseases.
Sudden weight loss.

What are the defined norms of blood parameters for a healthy person, see the picture:

The second part of the table in the following picture:

The age of the patient is not important. All these signs will appear in the presence of this disease. If intoxication affects the brain, neurological symptoms appear: headaches, epiactivity, vomiting, ICP, hearing and vision impairment.

Children may exhibit the following symptoms:

Memory impairment;
Apathy and reluctance to play;
Stomach ache;
Gait changes.

How to diagnose?

Since AML always manifests itself abruptly, it will not be possible to delay going to the doctor. At the appointment, the specialist will offer a whole range of measures that will allow you to make an accurate diagnosis and select the optimal treatment methods. First, inspection and questioning. Then the following diagnostic procedures are suggested:

General blood test. Here they will pay special attention to the number of leukocytes in the blood. In the blood of patients, the number of immature white cells increases, and a change in the number of platelets is noted. A blood test is one of the main ones on this list.
Blood chemistry. Such an analysis for leukemia will show a high content of vitamin B12, as well as uric acid and a number of enzymes.
Bone marrow biopsy.
Cytochemistry – blood and bone marrow samples are taken for study.
Ultrasound - this method helps to determine the increase in the size of the liver and spleen (these organs usually increase with this pathology).
Genetics research.

Based on the data obtained, the doctor will be able to make an accurate diagnosis and determine the direction of therapy.

How to treat?

Medical procedures include the following options:

Chemotherapy;
Radiation therapy;
If necessary, a bone marrow transplant, as well as stem cells (material is taken from a donor);
Leukapheresis is a procedure where changed cells are removed;
Splenectomy.

However, in most cases, curing the disease is difficult and even impossible. Therefore, therapy is more symptomatic. With its help, they alleviate the patient’s condition and support his vital functions.

Leukemia, or, in medical terms, hemoblastosis, is a malignant tumor originating from hematopoietic cells. Depending on whether the leukemic clone arose from blast (young) blood cells or their mature forms, leukemia can be acute or chronic. Acute myeloblastic leukemia accounts for 20% of all cases of childhood hemoblastosis. Among adults, the incidence increases sharply after 60 years.

general characteristics

Precursors of blood cells are divided into 2 large groups - lymphocytic and myelocytic lineage. The lymphocytic germ creates lymphocytes: cells “responsible” for immune reactions. The myelocytic lineage develops (differentiates) into erythrocytes, platelets, neutrophilic leukocytes and granulocytes. Immature blood cells are called blasts.

Thus, acute myeloid leukemia is a tumor that arises from immature cells of the myelocytic lineage of hematopoiesis.

The diagnosis is considered established if the bone marrow analysis (myelogram) shows more than 20% blast cells.

Causes and mechanisms of development

Acute myeloid leukemia (AML), like any leukemia, arises from a single mutated cell that loses its ability to mature and begins to multiply uncontrollably. It is usually impossible to say exactly which of the known carcinogenic factors provoked mutations in each specific case, especially when it comes to children. In general these could be:

Biological factors: oncogenic viruses, the most famous of which is Epstein-Bar.
Chemical substances. In total, more than one and a half thousand carcinogenic compounds are known. These include: products of incomplete combustion of tobacco; substances arising from incomplete oxidation of fats (deep frying); industrial “hazards” that appear during the thermal treatment of oil, resins, and coal; mold waste products; medications used for chemotherapy of malignant tumors (sadly, there are cases when leukemia occurs 10-20 years after successful removal of cancer).
Physical factors. This is mainly ionizing or x-ray radiation: it is known that for X-ray room workers the likelihood of getting sick is higher than the average for the population.

In addition to external influences, heredity matters: it is known, for example, “leukemia of twins,” or passed on in the family from generation to generation. It is not the disease itself that is inherited, but gene or chromosomal mutations that increase its likelihood. In addition, some congenital pathologies are combined with a higher incidence of leukemia, in particular myeloid leukemia:

Down syndrome;
neurofibromatosis type 2;
Falconi's anemia;
severe congenital anemia;
congenital thrombocytopenia or thrombocytopathy.

The pathogenesis, or development mechanism, of myeloblastic leukemia is based on competition between normal and tumor cells. Initially, one single atypical cell in 3 months is capable of generating 1012 - one trillion - daughter blasts, with a total mass of more than a kilogram. Malignant cells live longer because their mechanism of “aging” and natural death is turned off. They produce substances that inhibit the activity of healthy blood elements and suppress growth factors. In such a situation, the possibilities of normal hematopoiesis are gradually depleted.

In addition, the body, “seeing” a huge number of myeloblasts in the bone marrow and vascular bed, begins to slow down the activity of hematopoiesis: since all cells are somehow differentiated from blast cells, it perceives degenerative, malignant cells as “normal”. This is another mechanism that allows oncology to win the competition. As hemoblastosis develops, malignant cells begin to multiply in other tissues and organs: liver, spleen, lymph nodes, skin and even meninges.

It is the replacement of healthy blood cells with a mass of blasts, unable to perform their functions due to immaturity, that forms the symptoms of leukemia.

Clinical picture

Manifestations of acute myeloid leukemia are nonspecific - this means that at the initial stage the symptoms resemble those of other diseases.

Anemic syndrome

Due to insufficient hematopoiesis, the number of red blood cells decreases. General weakness, pallor, brittle nails and hair loss usually either do not attract the attention of the patient or his relatives, or are associated with other problems. As the disease progresses, weakness increases, shortness of breath appears even with minimal exertion, children stop playing outdoor games (in general, a decrease in a child’s activity is a reason to take a closer look at his health).

Hemorrhagic syndrome

Not only red blood cells, but also platelets become scarce in the blood. Blood clotting is impaired. Bleeding of varying intensity occurs: from pinpoint subcutaneous hemorrhages to heavy intracavitary hemorrhages (gastrointestinal, uterine, etc.).

Infectious and intoxication syndromes

Granulocytic leukocytes, belonging to the myelodine lineage, are cells whose function is to protect the body from microbes. They contain many proteins - natural antibiotics, peroxides, and other substances aimed at destroying the infectious agent. Inhibition of the hematopoietic germ also affects them, disrupting the body’s ability to fight pathogenic microbes. This is manifested by various purulent inflammations: skin abscesses, phlegmon, even sepsis. Any inflammation causes intoxication - poisoning by metabolic products of pathogenic microorganisms. Intoxication syndrome is manifested by such symptoms as:

weakness;
temperature increase;
sweating;
loss of appetite, weight loss;
vague muscle pain.

Hyperplastic syndrome

Occurs in 30-50% of patients. Tumor cells fill not only the bone marrow, but also the lymph nodes, liver, and spleen. The organs enlarge, remaining painless, their consistency becomes doughy. Hyperplasia itself is not dangerous, but if lymph nodes that are located in a confined space (for example, the mediastinal cavity where the heart is located) grow, they can put pressure on vital organs.

Neuroleukemia

In 5-10% of children, leukemia cells create “metastases” - tumor growth sites in the cranial cavity, meninges, and large nerves. As a result, signs of damage to these organs arise: impaired sensitivity and function of the limbs due to infiltration of peripheral nerves, symptoms of meningitis and brain tumors due to the growth of infiltrate inside the cranial cavity.

Leukemia cells can form areas of extramedullary (literally translated - located outside the bone marrow) tumors in the bones, on the skin and mucous membranes, mammary glands, uterus and appendages, prostate, lungs. In this case, symptoms characteristic of the pathology of these organs arise.

Diagnostics

The main sign of leukemia is considered to be the so-called leukemic failure: when many blasts are visible in the analysis, few mature cells and transitional forms are completely absent. But in practice, as noted in clinical recommendations, in the early stages of the disease there may not be leukemia cells in the hemogram (blood test). The main basis for diagnosing acute myeloid leukemia is more than 20% of blasts in (bone marrow punctate analysis).

Theoretically, diagnosis should include cytogenetic tests, when specific gene mutations that cause leukemia are studied. This is one of the most important prognostic factors and the modern WHO classification includes a description of more than ten gene abnormalities that directly affect the prognosis. Unfortunately, in Russia, cytochemistry, cytogenetic, molecular genetic and other similar studies can only be done in large centers.

Treatment: general principles

During the period of polychemotherapy - treatment aimed at the death of the leukemic clone, the patient requires hospitalization and special care: conditions close to sterility. Nutrition should be complete, high in protein. All food must be subjected to heat treatment.

In addition to chemotherapy aimed at the cause of the disease, supportive therapy is also required for leukemia. It is needed in order to treat and correct the main syndromes of the disease: for anemia, red blood cells are transfused, for hemorrhages, platelets are given, infections are treated with antibiotics, and so on. Maintenance treatment is also necessary to prevent complications of chemotherapy.

Treatment approaches for children and adults differ.

Treatment and prognosis: children

In childhood, the standard is intensive polychemotherapy, supplemented by bone marrow transplantation.

First you need to induce remission. To do this, they use a combination of 5 drugs that are administered according to a specific schedule. After the blast cells in the bone marrow become less than 5%, they switch to maintenance therapy: up to 4 courses of a cytostatic drug. Then, if possible, a bone marrow transplant is performed (except for patients in the favorable prognosis group). But the possibility of transplantation depends on whether a suitable donor is found. In practice, this means that if he is not among his close relatives, the possibility of transplantation tends to be zero: a register of bone marrow donors is being compiled in Russia, but for now it is not even possible to undergo typing in all major cities.

Belonging to the group of favorable, intermediate and unfavorable prognosis depends on the genotypic characteristics of leukemia. In addition, the patient’s individual response to therapy is important: if 2 weeks after its start the number of blasts in the bone marrow decreases to 5-15%, the likelihood of a favorable outcome increases sharply.

If remission lasts longer than 5 years, leukemia is considered cured. But relapses are also possible. The relapse-remission cycle can continue either until the condition stabilizes or until hematopoietic resources are completely depleted - in this case the prognosis is unfavorable.

In case of relapse, polychemotherapy is carried out in 3 stages: induction of remission, consolidation of remission and a course of maintenance therapy.

In general terms, the survival prognosis can be described using the table:

	Achievement of remission, %	Probability of overall survival in the next 4 years, %	Probability of disease-free survival in the next 4 years, %
All patients	90	67	61
Standard risk group	91	78	71
High risk group	87	55	46

As you can see, it is in principle possible to cure acute myeloid leukemia in children.

Treatment and prognosis: adults

Factors influencing the prognosis in adult patients can be divided into 3 groups:

Individual characteristics of the body and health status;
Biological characteristics of the leukemic clone;
Correct selection of treatment method.

Individual characteristics

Both leukemia itself and its treatment place a huge burden on the body. Therefore, the older the patient, the worse the prognosis. Firstly, with age, chronic pathologies become more and more severe, and their course is more severe. And even relatively healthy patients over 60 tolerate treatment worse than younger ones.

Secondly, with age, adverse effects on the genotype accumulate, and the likelihood of mutations with a poor prognosis becomes higher.

Biological characteristics of the leukemia clone

Just like in children, the most important prognostic factor is the genotype of leukemia cells. Cytogenetic research and assignment to a group of favorable, unfavorable or intermediate prognosis is necessary for the correct selection of a treatment regimen. In practice, in Russia such a study is carried out in no more than 60% of patients. This leads to the third factor.

Adequacy of chemotherapy

This factor is not included in foreign clinical recommendations; unfortunately, it is relevant exclusively for Russia. Even correctly prescribed medications may turn out to be less effective than necessary if the calculated doses of the medication are reduced, the intervals between courses are not observed, and similar “external” factors. In addition, belonging to one or another risk group in adults determines the need for bone marrow transplantation, and if a cytogenetic study has not been carried out, it is impossible to classify the patient into one of the three groups. Russian clinical guidelines suggest focusing on clinical signs as factors of unfavorable prognosis:

age over 40 years;
blood leukocytes > 100 x 10 9 /l;
presence of extramedullary lesions;
remission did not occur after the first course of chemotherapy;
secondary AML (occurred after a course of chemotherapy for another malignancy);

Contraindications

Polychemotherapy is the only way to destroy the clone of leukemia cells. But when it comes to adult patients with concomitant diseases, we have to consider contraindications:

myocardial infarction less than a month before the start of treatment;
congestive heart failure;
heart rhythm disturbances accompanied by unstable hemodynamics;
renal failure except when it is caused by leukemic infiltrate;
acute viral hepatitis;
liver failure except in cases caused by leukemic infiltrate;
severe pneumonia other than caused by leukemia cells;
sepsis;
life-threatening bleeding;
severe mental pathologies;
exhaustion;
diabetes mellitus with a blood glucose level >15 mmol/l that cannot be compensated;
concomitant oncological pathology with an uncontrolled course.
In these conditions, aggressive polychemotherapy will definitely do more harm than good. But if the condition has been stabilized, then after a week you can begin a course of treatment.

Chemotherapy itself is divided into 3 stages:

induction of remission (1-2 courses);
consolidation of remission (1-2 courses) – the most aggressive and high-dose stage;
anti-relapse treatment.

Specific regimens and course duration vary depending on prognosis and previous relapses.

After achieving remission, bone marrow transplantation from a compatible donor is recommended for high-risk patients. As with the treatment of children, the possibility of using this method is limited by the availability of a donor. Despite the danger of transplantation for older patients (mortality rate 15-50%), there are practically no relapses after it.

Maintenance chemotherapy is prescribed for 1-2 years after the start of remission (options from 4 to 12 courses are possible). The number and duration of courses, as well as the intervals between them, depend on the patient’s risk group and response to treatment.

Unfortunately, at least 60% of adult patients relapse within 3 years. Therefore, it is quite difficult to talk about the prospects for recovery.

Five-year survival rates range from 4 to 46%. The prognosis depends on the genetic characteristics of leukemia, the general condition of the patient and the duration of remission.

Blood diseases are always very dangerous for humans. First, blood comes into contact with all tissues and organs inside the body. To perform its functions of saturating cells with oxygen, nutrients and enzymes, blood circulation must function correctly and cellular composition must be within normal limits.

Secondly, blood cells ensure the functioning of the body's immune system. Acute myeloblastic leukemia disrupts the structure of cells and causes a decrease in immunity.

Acute and chronic form

Acute myeloid leukemia (AML) develops when immature cells called blasts undergo changes. At the same time, the body lacks mature elements, while the pathological form of blast transformation increases at high speed. The process of changing cellular structure is irreversible and cannot be controlled with medications. Acute myeloid leukemia often leads to the death of the patient.

The cell change affects one of the types of white blood cells, granulocytes, which is why there is a common popular name “leucemia”. Although, of course, the color of the blood does not change during the disease. Leukocyte cells that have granules (granulocytes) undergo changes.

Chronic myeloid leukemia (CML) occurs when the cellular structure of mature granulocytes undergoes a change. During this pathology, the body's bone marrow is able to produce new cells that mature and turn into healthy granulocytes. Therefore, chronic myeloid leukemia does not develop as quickly as acute leukemia.

A person may not be aware of changes in white blood cells for years.

Myeloid leukemia is a very common disease among blood diseases. For every 100 thousand people there is 1 patient with leukemia. This disease affects people regardless of race, gender and age. However, according to statistics, leukemia is more often diagnosed in 30-40 year old people.

Causes of the disease

Doctors call the main cause of the development of myeloid leukemia a chromosomal translocation, which is also known as the “Philadelphia chromosome.” As a result of the disorder, sections of the chromosomes change places and a DNA molecule with a completely new structure is formed. Then copies of malignant cells appear and the pathology begins to spread. Myeloid tissue is used to make white blood cells. The blood cells then change and the patient develops myeloid leukemia.

The following factors may predispose to this process:

Radiation exposure. The harmful effects of radiation on the body are widely known. People may be exposed to radiation in areas of man-made disasters and in some production areas. But more often, myeloid leukemia becomes a consequence of previous radiation therapy against another type of cancer.
Viral diseases.
Electromagnetic radiation.
The effect of some medications. Most often we are talking about drugs against cancer, since they have an intense toxic effect on the body. Ingestion of certain chemicals can also lead to myeloblastic leukemia.
Hereditary predisposition. People who inherited this ability from their parents are more likely to experience DNA changes.

Acute symptoms

During the acute course of the disease, leukocyte cells change and multiply at an uncontrolled rate. The rapid development of cancer leads to the appearance of such signs of the disease that a person cannot ignore. Acute myeloblastic leukemia manifests itself with severe malaise and pronounced symptoms:

One of the first characteristic signs of leukemia is pale skin. This symptom accompanies all diseases of the hematopoietic system.
A slight increase in body temperature within 37.1–38.0 degrees, excessive sweating during night rest.
A rash appears on the skin in the form of small red spots. The rash does not cause itching.
Acute myeloid leukemia causes shortness of breath even with mild physical exertion.
A person complains of pain in the bones, especially when moving. However, the pain is usually not severe and many patients simply do not pay attention to it.
Swelling appears on the gums, bleeding and the development of gingivitis are possible.
Acute leukemia causes the appearance of hematomas on the body. Red and blue spots can appear on any part of the body and are one of the obvious characteristic symptoms that this disease causes.
If a person is often sick, has a weakened immune system and is highly susceptible to infections, the doctor may suspect acute myeloid leukemia.
With the development of leukemia, a person begins to lose weight sharply.
Changes in certain types of leukocytes lead to a decrease in immunity and a person becomes vulnerable to infectious diseases.

Symptoms of the chronic form

Chronic leukemia may not show any symptoms in the first months or even years of the disease. The body tries to heal itself by producing new granulocytes to replace the changed ones. But, as you know, cancer cells divide and degenerate much faster than healthy ones, and the disease gradually takes over the body. At first, the symptoms appear weakly, then become stronger and the person is forced to consult a doctor with unwellness.

Usually only after this is a diagnosis of chronic myeloid leukemia made.

Medicine distinguishes three stages of this disease:

Chronic myeloid leukemia begins gradually, with changes in several cells. Chronic myeloid leukemia and symptoms that are mild do not cause the patient to see a doctor. At this stage, the disease can only be detected using a blood test. The patient may complain of increased fatigue and a feeling of heaviness or even pain in the left hypochondrium (in the area of the spleen).
At the acceleration stage, the signs of leukemia are still weak. There is an increase in body temperature and fatigue. The number of altered and normal leukocytes is growing. A detailed blood test may reveal an increase in basophils, immature white blood cells, and promyelocytes.
The terminal stage is characterized by the manifestation of pronounced symptoms of chronic myeloblastic leukemia. The body temperature rises, in some cases up to 40 degrees, severe pain in the joints and a state of weakness appear. Upon examination, patients are found to have enlarged lymph nodes, an enlarged spleen, and lesions of the central nervous system.

Diagnostics

To diagnose acute myeloid leukemia, you must undergo a thorough examination at a medical facility and undergo tests. Various diagnostic procedures are used to detect leukemia. Diagnostics begins with questioning and inspection. People suffering from myeloid leukemia are characterized by enlarged lymph nodes, enlarged liver and spleen.

Based on the results of the examination, tests and diagnostic procedures are prescribed:

General blood analysis. As a result of the study, patients with leukemia observed an increase in the number of immature white blood cells (granulocytes). The platelet count also changes.
Blood chemistry. Biochemistry reveals high amounts of vitamin B12, uric acid and some enzymes. However, the results of this type of study can only indirectly indicate myeloblastic leukemia.
Bone marrow biopsy. One of the most accurate studies in the diagnosis of leukemia. It is carried out after blood tests. As a result of puncture, a large number of immature leukocyte cells are also found in the bone marrow tissue.
Cytochemical analysis. The test is performed on blood and cat brain samples. Special chemical reagents, when in contact with biological samples from the patient, determine the degree of enzyme activity. In myeloblastic leukemia, the effect of alkaline photophosphase is reduced.
Ultrasonography. This diagnostic method allows you to confirm enlargement of the liver and spleen.
Genetic research. It is not carried out for diagnosis, but to make a prognosis for the patient. The nature of chromosomal disorders allows us to draw conclusions about future treatment methods and their effectiveness.

Prognosis and treatment

Acute myeloid leukemia very often leads to the death of the patient. Predictions can only be made after a complete examination of the patient and discussion of possible ways to treat the disease. Chemotherapy is used to treat acute myeloid leukemia. There is a specific treatment plan and principle of therapy, which is called induction.

During treatment, a complex of drugs is used, the administration of which is scheduled on a daily basis.

In the second phase of treatment, if the therapy has worked and remission has begun, drugs are selected to consolidate the result according to the individual characteristics of the patient. During the destruction of altered granulocytes with drugs. A certain amount of them remains and a relapse of the disease is possible. To reduce the likelihood of re-development of myeloblastic leukemia, complex therapy is carried out, including stem cell transplantation. Diagnosis of chronic myeloid leukemia and treatment should be carried out under strict medical supervision. All test results must be interpreted by physicians specializing in blood diseases.

Medicine offers the following treatment methods:

Chemotherapy.
Radiation therapy.
Bone marrow and stem cell transplant from a donor.
Extraction of altered leukocyte cells from the body using leukapheresis.
Splenectomy.

It is very difficult to cure the disease. Therapy is usually intended to alleviate the patient's condition and support his vital functions. However, with successful treatment, people suffering from chronic leukemia live for decades. Treatment takes a long time, but medical statistics know many cases of remission in patients with blood cancer.

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