OVERVIEW

What is Acute Myeloid Leukemia?

Leukemia is a malignant tumor of the blood system.

It refers to the uncontrolled proliferation of leukemia cells in the bone marrow, gradually replacing normal hematopoiesis, preventing the normal production and function of red blood cells, white blood cells, etc. This leads to a series of symptoms such as fever, infections, and bleeding, and may also cause multi-organ dysfunction or even death.

In medicine, leukemia with low cell differentiation and rapid disease progression is called acute leukemia.

Acute leukemia can be further divided into acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) based on cell type.

Patients with acute myeloid leukemia not only endure physical suffering but may also experience significant psychological distress. However, it is important not to lose hope in treatment.

If a family member or friend is diagnosed with acute myeloid leukemia, please provide them with sufficient emotional support and encourage them to actively pursue treatment.

Is Acute Myeloid Leukemia Common?

The incidence of acute myeloid leukemia in China is approximately 1.62 per 100,000 people, making it a relatively rare disease. However, it is the most common type of leukemia.

What Are the Types of Acute Myeloid Leukemia (AML)?

The current mainstream classification method is the World Health Organization (WHO) classification system, which divides AML into six groups based on cell morphology, immunophenotype, genetics, and clinical features:

• AML with recurrent genetic abnormalities
• AML with myelodysplasia-related features
• Therapy-related AML and myelodysplastic syndrome
• AML, not otherwise specified
• Myeloid sarcoma
• Myeloid proliferation associated with Down syndrome

Different types of AML require different treatment approaches and have varying disease outcomes.

SYMPTOMS

Under what manifestations might acute myeloid leukemia be suspected?

Acute myeloid leukemia can sometimes be very insidious, and many patients are discovered "accidentally."

Some are diagnosed after seeking treatment for sudden high fever resembling a "cold"; others are discovered due to prolonged bleeding after tooth extraction; and some are identified after seeking medical attention for persistent paleness or bruising of the skin.

What are the manifestations of acute myeloid leukemia?

Patients with acute myeloid leukemia often present with anemia, fever, and bleeding.

• Anemia: Patients may exhibit pale complexion, increased heart rate, palpitations, dizziness, and fatigue.

• Fever: This can range from low-grade fever to high fever of 40°C. The fever may be caused by leukemia itself or secondary infections. Common secondary infections include stomatitis, tonsillitis, pneumonia, perianal inflammation, and sepsis.

• Bleeding: This can occur anywhere in the body. Patients may notice petechiae, bruising, easy gum bleeding while brushing teeth, difficulty stopping bleeding after tooth extraction, or excessive menstrual bleeding. Severe cases may involve intracranial hemorrhage, leading to headaches, paralysis, or coma.

• Manifestations of leukemia cell infiltration into organs: When leukemia cells infiltrate different organs, various symptoms may arise.
  For example, infiltration of the oral cavity may cause gum hyperplasia and swelling; infiltration of lymph nodes, liver, or spleen may lead to lymphadenopathy and hepatosplenomegaly; skin involvement may present as blue-gray maculopapular rashes; central nervous system infiltration may cause headaches or dizziness; and testicular infiltration often manifests as painless swelling of one testicle.

CAUSES

What are the causes of acute myeloid leukemia?

The exact cause of leukemia is unclear, but it may be related to factors such as viral infections, immune dysfunction, exposure to excessive ionizing radiation like X-rays, contact with organic solvents such as benzene, and genetic predisposition.

DIAGNOSIS

What tests are needed for acute myeloid leukemia?

If acute myeloid leukemia is suspected, the main purpose of testing is to confirm the diagnosis, determine the subtype, develop an appropriate treatment plan, and assess the patient's prognosis.

Newly diagnosed patients should undergo comprehensive testing and evaluation. The most important tests include: complete blood count (CBC), blood smear differential, bone marrow examination (aspiration and biopsy), cytochemical staining, flow cytometry immunophenotyping, chromosome karyotyping, and genetic testing.

Additionally, patients need further tests such as liver and kidney function, electrolytes, coagulation function, lactate dehydrogenase (LDH), electrocardiogram (ECG), abdominal ultrasound, and chest CT to assist doctors in selecting chemotherapy regimens.

Being diagnosed with acute myeloid leukemia can be overwhelming, and some may even experience extreme thoughts. Others may feel guilty, believing they are burdening their families.

At this time, family and friends must provide the patient with ample support and companionship, helping them cope, adjust their mindset, and commit to treatment as soon as possible.

TREATMENT

Which department should I visit for acute myeloid leukemia?

Hematology.

What happens if acute myeloid leukemia is left untreated?

Without any treatment, the median survival time for acute myeloid leukemia is approximately 3 months. A very small number of patients may die within days of diagnosis.

What are the treatment options for acute myeloid leukemia?

Current treatments for acute myeloid leukemia include chemotherapy, targeted therapy, immunotherapy, hematopoietic stem cell transplantation (HSCT), etc.

Is there hope for a cure for acute myeloid leukemia (AML)?

Certain specific types of AML (such as acute promyelocytic leukemia) can achieve clinical cure through drug therapy. However, for most types of leukemia, the only potential cure currently is allogeneic transplantation.

A significant number of patients can achieve a cure or maintain long-term stable disease, so active treatment is essential.

How is chemotherapy administered for acute myeloid leukemia?

Chemotherapy is divided into two steps: the first is induction remission therapy, and the second is post-remission therapy.

Doctors will develop a personalized chemotherapy plan based on the patient's AML subtype, chromosomal type, gene mutation type, as well as age and general health condition.

Chemotherapy generally consists of multiple courses, with intervals of at least 2 weeks between courses. The impact of chemotherapy on normal cells is smaller than on leukemia cells, and the rest period after chemotherapy allows normal cells time to recover.

What are the side effects of chemotherapy drugs for acute myeloid leukemia?

Most chemotherapy drugs cause varying degrees of side effects, such as nausea, vomiting, poor appetite, and other gastrointestinal symptoms; rashes of varying severity, with severe cases accompanied by extensive peeling or purpuric rashes; dizziness, headaches; dry mouth, and chapped lips.

To reduce the discomfort caused by chemotherapy side effects, doctors often administer antiemetics before or during chemotherapy to minimize gastrointestinal reactions, antihistamines to reduce rashes, corticosteroids to lessen immune reactions, and supportive treatments like hydration and nutritional support.

What are the commonly used chemotherapy drugs for acute myeloid leukemia?

Commonly used chemotherapy drugs include:

• Anthracyclines: Such as "Idarubicin," with brand names like "Idamycin" or "Zavedos." The most common side effect of these drugs is cardiotoxicity, which may lead to tachyarrhythmia or heart failure.

• Homoharringtonine: Its most significant side effect is bone marrow suppression.

• Cytarabine: Brand name "Cytosar."

• Arsenic agents: Such as arsenic trioxide.

DIET & LIFESTYLE

What should patients with acute myeloid leukemia pay attention to in daily life?

During chemotherapy, patients often experience the side effect of bone marrow suppression, where chemotherapy drugs kill a large number of cells, including not only malignant tumor cells but also normal white blood cells, red blood cells, and platelets.

As a result, patients may experience infections, anemia, or prolonged bleeding. Therefore:

• If platelet counts are severely low, patients should reduce physical activity and, if necessary, remain on strict bed rest, including using a bedpan for toileting.
• Avoid excessive straining during bowel movements; laxatives may be used if needed.
• Do not pick the nose, use toothpicks, or scratch the skin with nails.
• Avoid crowded or poorly ventilated areas and wear a mask when going out to prevent infections.

How should acute myeloid leukemia patients follow up for re-examination?

Patients should adhere to their doctor's instructions and return to the hospital regularly for follow-up examinations, including blood tests and bone marrow aspiration.

How can acute myeloid leukemia patients receive timely blood transfusions?

Patients with acute myeloid leukemia may require blood transfusions due to low hemoglobin or platelet counts, but blood products in hospitals are often in limited supply.

To ensure timely transfusions, family members can inquire in advance at blood banks or transfusion departments and explore options like mutual-aid blood donation to obtain blood products more quickly.

PREVENTION

Can Acute Myeloid Leukemia Be Prevented?

The exact cause of leukemia is currently unclear, so there is no definitive and effective prevention method.

However, current research suggests that leukemia may be related to factors such as viral infections, radiation exposure, and chemical toxins. Reducing exposure to radiation, organic solvents like benzene, and chemical reagents such as low-quality hair dyes in daily life may help lower the risk of developing leukemia.