aml | Acute myeloid leukemia

Acute myeloid leukemia

Your doctor has taught you that you have been reached
"Acute myeloid leukemia" (LAM).
The term "leukemia" means that there are
In your blood tumor cells. This is
Blasts. In the normal state, these cells are originally
of a type of white blood cells (polynuclear).
The term "myeloid" refers to the marrow
Bone, that is, the tissue contained in the
Bone where all blood cells are produced
(not to be confused with the spinal cord that
belongs to the nervous system). The blasts
Accumulate in fact in the bone marrow.
The term "acute" means that the disease is installed
Quickly: A few days or weeks
Barely take place between the first symptoms
and diagnosis. Treatment is carried out in the
Days, or even hours, that follow the latter.
Acute myeloid leukemia is cancerous in nature. It is linked to the multiplication
Uncontrolled of abnormal blasts that invade the bone marrow. It cannot
To function properly and, in particular, to ensure the production of the cells
Normal blood. We are talking about medullary failure.
The consequences are the occurrence of anemia (decrease of red blood cells
and hemoglobin) that results in fatigue, pallor, shortness of breath and palpitations.
Due to the decrease in other white blood cells called neutrophils
(neutropenia), the organism is more susceptible to infections, especially pulmonary.
Finally, the lesser number of platelets (thrombocytopenia) can cause
Bleeding, especially in the mucous membranes (nosebleed,
Gums) and skin (bruises or "bruises" at the slightest shock).
The accumulation of blasts in the bone marrow, but also in other organs
May cause other disorders: bone pain, increased size of the
Lymph nodes, spleen, liver, gums... In rare cases, blasts pass through
Cerebrospinal fluid, which is located around the brain and spinal cord,
That can lead to nerve and brain damage. All these symptoms and
disorders are not systematic.
LAM is a disease that can occur at any age, but only 25% of cases
Are diagnosed before age 25. It is especially after 40 years that the frequency of
Disease increases, the average age at the time of diagnosis being 65 years.
The origin of LAM is most often unknown. Ionizing Radiation and
Exposure to benzene is recognized in France as a professional cause
That may be responsible for acute leukemia. The chemotherapy and the
Proposed radiotherapy for the treatment of other cancers may also have been
Challenged. Finally, the pre-existence of other diseases, particularly affecting the marrow
(Myélodysplasies), also predisposes to the occurrence of a LAM. This
Disease is neither contagious nor hereditary.

The diagnosis
The diagnosis of LAM is mainly based on an examination of the bone marrow
Called Myelogram. Carried out under local anesthesia, it consists of inserting a
Hollow needle in a bone. This is usually the sternum (flat bone located in the middle
of the breast) or the pelvic bone (pelvic bone). A small amount of marrow is then
which allows the analysis of abnormal cells, their chromosomes and their
Genes. The results obtained are decisive for the choice of treatment.
At the same time, a blood count (NFS), made from a
To quantify the different blood cells and detect
The anomalies present. Finally, an analysis of the cerebrospinal fluid can be
Carried out in some cases to seek a possible neurological damage. She
Requires a lumbar puncture, i.e. a puncture between two
Lower back vertebrae. This examination is also carried out under local anesthesia.

Different types of disease
According to an international classification called FAB (for Franco-AméricanoBritannique),
Eight types of LAM are distinguished. They are rated from 0 to 7; We're talking
So, for example, of LAM1 or LAM4. These different types differ
Mainly by the characteristics of abnormal cells observed through acute myeloid leukemia (cont'd)

to the Myelogram. This classification does not reflect the severity of the disease. The

Treatment is essentially the same for all types of LAM, except for some

Minority subtypes (LAM3) justifying more specific drugs.

The treatments

The treatment aims to obtain the disappearance of the abnormal blasts, thus allowing the

Normal bone marrow to reconstitute the populations of blood cells (globules

White and red, platelets). It usually consists of several phases:

• Induction. This chemotherapy treatment lasts from seven to ten days. Its objective

is to obtain a remission, i.e. the disappearance of the signs of the disease;

Abnormal blasts are no longer detectable in the bone marrow and blood,

Medullary deficiency is corrected. This treatment takes about a month

Time required for the bone marrow to reconstitute the cells of the

Blood. Once the complete remission is obtained, the doctors know that a small number of

Of abnormal cells persist in the bone marrow. Other processing steps

are necessary.

• consolidation. This treatment is intended to maintain remission. It consists of

Administer high doses of chemotherapy. Several consolidation cycles are

Usually necessary, justifying new hospitalizations more or less

Long.

• intensification. This type of treatment is proposed and adapted according to the risk of

Relapse of leukemia and is variable from one subject to another in order to obtain a remission

Prolonged and healing. It rests on several cures of chemotherapy near

or identical to that administered during consolidation, or on a cell transplant

Hematopoietic strains. In the latter case, it may be a transplant performed at

From a donor (allograft) or through stem cells of the patient itself

That are collected at the end of the consolidation treatment (Autograft). The cells

Strains are bone marrow cells (which are also present in the blood

from which all blood cells are produced.

Intensification can only be considered in patients under the age of

60-70 years because, beyond this age, the body is no longer able to support the

Adverse effects of this type of treatment. Maintenance treatments for the remission

Can then be proposed as appropriate.

The various treatments proposed expose to adverse effects, in particular

A aplasia, that is, a significant drop in all blood cells. It

is transient and lasts from a few days to several weeks. During this period,

The patient finds himself helpless in the face of infection. Hospitalization in the middle

Protected is often necessary. Specific information on other effects

Potential undesirables is delivered by the doctor before any treatment begins.

The Monitoring

Once all the treatments are complete, monitoring is essential. She

Requires regular consultation with the Hematologist doctor to detect

Possible relapse and any late complications of treatment. A

Blood control formula count must thus be performed at regular intervals

At first, then in a more spaced way.

Acute leukemia is far from a "hopeless" prognosis, healing

Can be obtained when the remission extends beyond a few years.