Leukemia is cancer of white blood cells known to take the lives of 24,000 patients every year in the United States. There are many different types of leukemia, reflecting the diversity of the different types of white cells found in the human body and the different ages at which leukemia can develop. The most common kind of leukemia is acute myelogenous (or myeloid) leukemia.

AML is a cancer of the myeloid lineage cells of the bone marrow and commonly includes a collection of abnormal white blood cells in the bone marrow. There is a common misconception that leukemia mostly affects children, but AML is actually frequently found in adults. AML is the most common acute leukemia in adults and usually hits people at 63 years of age, on average, and it is relatively rare in children. There are approximately 18,860 new cases of acute myeloid leukemia annually in the United States, and approximately 10,460 deaths occur annually in the U.S. from AML.

The diagnosis of AML is generally presented with anemia and/or thrombocytopenia, followed by a bone marrow aspiration or biopsy revealing the presence of the leukemia cells, differentiating AML from ALL (acute lymphoblastic leukemia). The expansion of the AML cells in the bone marrow causes a decrease of normal blood cell production, which results in anemia (decrease in red blood cells), and an increase in infections (due to a decrease in white blood cells).

One cause of AML is prior radiation or chemotherapy for treating cancer in which the highest risk is 3 to 5 years after exposure. Other risks include genetics and pre-leukemic disorders such as myelodysplastic syndrome (MDS) and myeloproliferative disease (MPS).

Acute myeloid leukemia has been sub-divided in a number of classification systems, typically into about 9 sub-types, usually based on a cytogenetic analysis of chromosomal translocations, inversions, and/or deletions.

Prognosis varies considerably depending on the sub-type of the disease and successful treatment is also highly dependent on the exact classification. The most critical identification that can be made is the t(15:17) translocation, which characterizes acute promyelocytic leukemia. This can be successfully treated with all-trans retinoic acid and additional chemotherapeutic agents.

Treatment for other sub-types of AML begins with cytarabine (ara-C) and an anthracycline. For patients with sub-types of AML with relatively good prognoses, this treatment will be followed up with several additional courses of chemotherapy while patients with relatively poor-prognosis subtypes will be considered for stem cell (bone marrow) transplantation. The five-year survival rate varies from 15-70% depending on sub-type, with overall survival rates in the 20-45% range, rising to as high as 98% in cases of acute promyelocytic leukemia. Internal tandem duplications of the Flt-3 gene (Flt3-ITD) have been shown to be associated with a particularly poor prognosis in cases of AML.

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Categories: Oncology

Tags: AML, leukemia