Acute Myelogenous Leukemia (AML)
Acute myelogenous leukemia (AML) is a cancer caused by exposure to benzene that attacks tissue inside the bones where the body makes blood cells. AML may also be referred to as acute granulocytic leukemia, acute myeloid leukemia, acute myeloblastic leukemia and acute nonlymphocytic leukemia.
The symptoms of AML may depend upon the type of blood cell concerned. Generally, though, the symptoms of AML in the early stages are similar to those of the flu. If you are experiencing any of the following symptoms and are concerned, you should contact your doctor right away, since AML progresses rapidly if not treated. AML symptoms include:
- Bone pain,
- Frequent infections,
- Pale skin,
- Shortness of breath,
- Susceptibility to bruising, and
- Unusually frequent nosebleeds or bleeding from the gums.
When you visit your doctor, a number of tests are likely to be performed before a diagnosis can be reached. These tests include:
Blood tests. Blood tests are useful in determining whether it is likely that a person has AML. Generally, tests of AML patients will reveal too many white blood cells, too few red blood cells and a shortage of platelets. In addition to testing for these, your doctor will also look for blast cells, which are immature cells usually present in bone marrow but not in the blood – except where AML is present.
Bone marrow biopsy. A bone marrow test is performed to confirm a suspected diagnosis of AML. During the procedure, a needle is inserted – usually into the hipbone – to extract a sample of bone marrow that is sent for testing by a laboratory.
Lumbar puncture. Often called a spinal tap, this procedure is sometimes used to remove fluid from around the spinal cord to see whether leukemia cells are present. A lumbar puncture involves the insertion of a small needle into the lower back where the spinal canal is located.
If your doctor makes a diagnosis of AML, you may be referred to an oncologist, a doctor who treats cancer patients, or a hematologist, a physician who specializes in blood-related diseases. A specialist is likely to conduct more tests to learn the extent of the cancer and its AML subtype. At this stage, your doctor will be looking at: the specific cell types involved; the level of maturity of the cancer cells; the degree to which the cancer cells differ from normal cells; and the location and number of specific changes in the DNA of the cancer cells. Different treatments work better for different AML subtypes, so it is important that your doctor conduct these additional tests.
Treatment for AML will vary according to your age, the subtype of the disease, your health in general and your own personal choice. Traditional AML treatment has two phases, the first of which attempts to kill as many of the leukemia cells as possible and the second which is aimed at destroying the rest. At times, a physician may suggest that instead of following a course of traditional treatment, you might consider participation in a clinical trial that offers an experimental therapy or a combination of the more usual treatments.
Remission Induction Therapy
The first phase of AML treatment is traditionally aimed at killing the bulk of the leukemia cells in the blood and bone marrow. Unfortunately, remission induction therapy rarely destroys all the leukemia cells, meaning that further treatment is necessary to prevent AML from returning.
The main form of remission induction therapy is chemotherapy, in which chemicals are employed to kill cancer cells in the body. During chemotherapy treatments, AML patients normally remain in the hospital because the chemicals used kill many healthy blood cells in addition to the leukemia cells. At times, the first cycle of chemotherapy is not successful, and must be repeated. Drugs that are commonly used in this initial phase of treatment include: cytarabine (ara-C); daunorubicin (DNR); etoposide; idarubicin; mitoxantrone; and thioguanine.
In addition to chemotherapy, other drugs may also be helpful during the remission induction phase. One subtype of AML called promyelocytic leukemia, for example, is a good candidate for treatment with all-trans retinoic acid (ATRA) and arsenic trioxide (Trisenox). Used alone or in combination with chemotherapy, these two anti-cancer drugs can be effective during remission induction to cause certain leukemia cells to stop multiplying, or to die entirely.
The second phase of traditional AML treatment is also known as maintenance therapy, post-remission therapy, or intensification. It is geared toward the destruction of any remaining leukemia cells to decrease the risk of relapse.
Chemotherapy is sometimes used in consolidation therapy, as well as in the remission induction therapy described above. In addition, patients whose disease is recently diagnosed, consolidation therapy often employs stem cell, or bone marrow, transplant. Stem cell transplant works by replacing diseased bone marrow with healthy stem cells that will themselves regenerate clean, leukemia-free bone marrow. Before the procedure, extremely high doses of either chemotherapy or radiation therapy are administered to kill off the leukemia-producing bone marrow. In an allogeneic transplant, the patient then is given infusions of stem cells taken from a compatible donor, usually a family member. Allogeneic transplant is usually performed only in patients under the age of 55. In an autologous transplant, a patient receives his or her own healthy stem cells that were removed while the patient was in remission and stored for a future transplant.
No alternative therapies have proven useful in combating AML, though many of the symptoms of AML (or its treatment) may be relieved by alternative treatments, including acupuncture, aromatherapy, meditation, massage and relaxation techniques.
Several well-known leukemia treatment centers are located in the United States. These include:
UAB Comprehensive Cancer Center, Birmingham, AL
Patient Information: 1-800-UAB-0933 or (205) 975-8222
Clinical Trial Information: (205) 934-0337
Robert H. Lurie Cancer Center, Northwestern University, Chicago, IL
Patient Information: (312) 908-5250
Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI
Patient Information: 1-800-865-1125
UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
Patient Information: (919) 966-3036
Clinical Trial Information: (919) 966-4432
M. D. Anderson Cancer Center, Houston, TX
Patient Information: 1-800-392-1611 or (713) 792-6161
If you have been diagnosed with acute myelogenous leukemia (AML) and you suspect that it may be related to benzene exposure, please contact us for a free consultation. You should know your legal rights.