WHAT IS ACUTE MYELOID LEUKAEMIA (AML) IN TEENS & YOUNG ADULTS 

Leukaemia is a cancer of the white blood cells in which the process for making new white blood cells gets out of control. Immature white blood cells (called blasts) keep being made and build up in the bone marrow until there isn’t enough room for the bone marrow to make healthy cells that help us fight infections (white cells); carry oxygen from the lungs around our body (red blood cells) and stops us bleeding when we cut ourselves (platelets) .

WHAT ARE THE SYMPTOMS OF AML IN YOUNG ADULTS?  

• Looking pale  and feeling tired – anaemic 

• Getting  bruised more easily and bleeding does not  stop

• Recurrent infections 

• Body aches and pains 

• Swollen glands (lymph nodes) in the neck, under-arms or groin

• Generally feeling unwell and run down

• Frequent fever and sweats 

• Headaches and blurred vision 

• Breathlessness

In rare cases of AML, the affected cells can spread into the central nervous system causing symptoms such as headaches, fits (seizures), vomiting, blurred vision and dizziness.

Causes: Acute myeloid leukaemia (AML) is caused by a DNA mutation in the stem cells in the bone marrow that produce red blood cells, platelets and infection-fighting white blood cells. Research is ongoing to find out the exact causes. Some factors though might increase the risk of contracting AML: 

1. Genetic conditions such as  Down's Syndrome, Fanconi’s anaemia

2. Few  non-cancerous conditions of the bone marrow such as aplastic anaemia or myelodysplastic syndromes

3. Radiation exposure

4. Benzene and Smoking

5. Previous Cancer Treatment

6. Blood disorders  such as myelodysplasia, myelofibrosis or polycythaemia vera (PCV) 

7. A number of other environmental factors too can trigger AML including childhood vaccinations and residing closer to a nuclear power station or a high-voltage power line.

DIAGNOSIS & TREATMENT

Diagnosis: Expert medical opinion should be sought in case of any of these symptoms to rule out the presence of disease. The diagnosis is arrived by one of the following ways: 

1. Bone marrow biopsy : The haematologist will extract a sample of liquid bone marrow that will be further  checked for cancerous cells from the back of the hip

2. Additional tests can be used to reveal more information like Genetic testing, etc. As knowing the exact type of AML can help doctors make decisions about the most appropriate treatment.

3. Scans such as Computerised Tomography (CT) , X-ray or echocardiogram (an ultrasound scan of the heart) to check organs  health.

4. Lumbar puncture to determine the risk of AML spreading  to the nervous system

Treatment:  AML in Teenagers & Adults is usually treated by a multidisciplinary team and is often carried out in two stages:

Stage 1- Induction – with an  aim initially to kill as many leukaemia cells in the blood and bone marrow, restore the blood to its proper working order. Followed by assessment for fitness for  intensive chemotherapy, or a lower dosage needs recommended under stringent medical monitoring. Regular blood transfusions would be required due to not enough healthy healthy blood cells in the patient.

Based on response to treatment, the Induction phase can last from four weeks to a couple of months. 

All Trans-Retinoic Acid (ATRA) : In cases when a patient has a sub-type of AML known as acute promyelocytic leukaemia, they would be additionally given ATRA medicine that works by changing the immature white blood cells (blast cells) into mature healthy cells, and reduces symptoms very quickly. 

Stage 2- Consolidation – Is directed to prevent the relapse of cancer by killing any remaining leukaemia cells present in the body. This involves regular injections of chemotherapy medication. It is usually an OPD procedure, however, short stays in hospital may be needed if symptoms suddenly get worse or if an infection develops. This phase may  last for several months.

In case there is  a relapse after treatment, both the re-induction and consolidation may need to be carried out once again. 

In addition, alternative methods of treatments are also used for AML:  

• Radiotherapy

• Bone marrow and stem cell transplants

Transplantations are most successful when  carried out on children and young people, and in some older people in good health, and when there's a suitable donor available.

IMPORTANT INFORMATION 

Side effects of Treatment may include: 

• nausea

• vomiting

• diarrhoea

• loss of appetite

• sore mouth and mouth ulcers (mucositis)

• tiredness

• skin rashes

• hair loss

• infertility 

Most side effects should resolve once treatment has finished. Speak with your Doctor, if the side effects worsen.