Symptoms, prognosis, and additional details regarding Acute Myelomonocytic Leukemia (AML) explained.
Acute Myelomonocytic Leukemia (AMML) is a rare subtype of acute myeloid leukemia (AML), accounting for 5-10% of all AML cases. This disease affects cells giving rise to white blood cells other than lymphocytes.
The overproduction of cells called myeloblasts and promonocytes in the bone marrow leads to a lack of healthy blood cells, resulting in symptoms such as low platelet count (thrombocytopenia) and low red blood cell count (anemia).
The primary goal of treatment for AMML is to achieve and maintain complete remission, defined as having less than 5% of blasts in the bone marrow and normal blood cell counts. The treatment for AMML has two phases: Induction and Consolidation.
In the Induction phase, doctors aim to induce remission. For those under age 60, more intensive treatment is given, while older individuals receive a less intensive treatment. The main drugs used in this phase are cytarabine and an anthracycline drug such as daunorubicin.
During the Consolidation phase, doctors may give several cycles of high-dose chemotherapy, depending on the person's age and health status. The primary treatment for people with AMML is chemotherapy. However, in some cases, doctors may add targeted therapy drugs or consider stem cell transplants for certain people with AMML.
The treatment cost for having AML goes over $400,000, with patients who receive Hematopoietic Stem Cell Transplantation (HSCT) managing higher charges.
It is essential to understand that the chromosomal abnormalities in AMML play a significant role in prognosis. Key abnormalities and their impacts are:
- Chromosomal translocations involving the MLL (KMT2A) gene on chromosome 11q23, such as t(9;11)(p22;q23), are frequently found in AMML. These rearrangements can influence prognosis variably but often indicate an intermediate to poor risk.
- Mutations in genes such as ASXL1, TP53, NRAS, and U2AF1 are linked to poor prognosis in AML, including AMML. Specifically, ASXL1 mutations are associated with shorter overall survival and worse outcomes.
- Favorable mutations like NPM1 mutation without FLT3 internal tandem duplication (ITD) or with FLT3-ITD plus tyrosine kinase inhibitor (TKI) therapy, and CEBPA bZIP domain mutations, are associated with better leukemia-free and overall survival.
- The presence of chromosomal aneuploidies generally portends a better prognosis in pediatric AML, although specific data on AMML are less clear.
Genetic and chromosomal abnormalities inform risk stratification, which is critical to deciding eligibility for intensive therapies like HSCT and use of targeted treatments. Poor-risk mutations increase relapse risk and reduce overall survival, leading to more aggressive disease and resistance to standard chemotherapy. Favorable genetic profiles guide clinicians to less intensive treatments or provide rationale for targeted therapies, potentially improving outcomes.
AMML affects males slightly more than females, and the median age of those with AMML is 50. It is crucial to note that doctors do not typically recommend radiation or surgery to treat AMML.
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[2] American Cancer Society. (2020). Acute myeloid leukemia (AML) - overview. Retrieved from https://www.cancer.org/cancer/acute-myeloid-leukemia/about/what-is-acute-myeloid-leukemia.html
[3] Leukemia & Lymphoma Society. (2020). Acute Myeloid Leukemia (AML). Retrieved from https://www.lls.org/leukemia/acute-myeloid-leukemia
[4] National Cancer Institute. (2020). Acute Myeloid Leukemia Treatment (PDQ®) - Health Professional Version. Retrieved from https://www.cancer.gov/types/leukemia/hp/aml-treatment-pdq
[5] Cancer Research UK. (2020). Acute myeloid leukaemia (AML): Diagnosis. Retrieved from https://www.cancerresearchuk.org/about-cancer/leukaemia/acute-myeloid-leukaemia/diagnosis
- Science has made significant strides in understanding the complexities of Acute Myelomonocytic Leukemia (AMML), a form of chronic disease classified under cancer, that accounts for 5-10% of all medical-conditions known as acute myeloid leukemia (AML) cases.
- AMML's primary symptom is an overproduction of cells called myeloblasts and promonocytes in the bone marrow, leading to a low count of healthy blood cells, such as platelets and red blood cells, and is commonly treated under health-and-wellness therapies and treatments like chemotherapy.
- During the journey of treatment for AMML, patients may face high costs, with the entire process typically costing over $400,000, and those undergoing Hematopoietic Stem Cell Transplantation (HSCT) bearing even higher charges.
- Understanding the genetics and chromosomal abnormalities related to AMML is vital in determining risk stratification, which, in turn, helps in deciding eligibility for intensive treatments like HSCT or targeted therapies for certain chronic diseases like neurological disorders, as poor-risk mutations increase the chance of relapse and reduce overall survival, whereas favorable genetic profiles may guide clinicians toward less intensive treatments or targeted therapies, potentially improving outcomes.
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