Treatment For Acute Myelogenous Leukemia
This disease, which is also called acute granulocytic leukemia, is caused by a malignant, or life-threatening, change in cells that produce granulocytes, one of the types of white blood cells made in the bone marrow. The resulting leukemic granulocytes multiply and survive longer than normal cells. As their numbers increase, the leukemic cells invade the bone marrow. This invasion disrupts the production of normal granulocytes, red blood cells and platelets.
Then, the leukemic granulocytes begin to enter the bloodstream, and their numbers increase fairly rapidly. Next they invade organs and tissues, particularly the spleen and liver. These organs become enlarged.
What are the Symptoms?
The common early symptoms of acute myelogenous leukemia are fatigue, infections (especially of the mouth and throat), fever, lip and mouth ulcers, and a tendency to bruise and bleed. You may also have the usual symptoms of anemia .
The disease often occurs suddenly, with the symptoms becoming pronounced over one or two weeks. But, sometimes, the symptoms appear gradually over two or three months. An elderly person may have what is called smoldering leukemia, in which the onset of the disease is very gradual. In such cases, treatment is usually postponed.
What are the Risks?
There is no cure for acute myelogenous leukemia. If it is not treated, it can be fatal within a few days or weeks. Even with successful treatment the average survival time after the disease is identified is about one year. The main hazards of this form of leukemia are serious infection and bleeding .
What should be Done?
Anyone with the symptoms described should see a physician immediately. After examining you, the doctor will probably arrange for you to have blood tests and usually a bone marrow biopsy. In a biopsy some of your bone marrow is removed and examined carefully under a microscope. If they are present, the cancer cells will be visible.
What is the Treatment?
As soon as the diagnosis of this disease has been confirmed, you will probably be admitted to a hospital. Because the treatment is complicated and difficult, it should generally be done by a physician who treats acute leukemia regularly. You should probably be in a large medical center where physicians are available around the clock. In the hospital, you will get transfusions of red blood cells and platelets when you need them. An antibiotic is usually prescribed to reduce the chance of infection. If you develop a fever or other evidence of infection, the infectious agent will be identified and antibiotics that are effective against it will be given to you intravenously. Transfusions of granulocytes may also be necessary. Platelet transfusions are usually done to prevent bleeding due to thrombocytopenia .
The treatment for the leukemia itself is the administration of strong cytotoxic, or anticancer, drugs. These drugs are given intravenously. Their purpose is to eliminate leukemic cells from the bone marrow, but they also destroy many of the normal blood cells that are in the bone marrow. This is, unfortunately, unavoidable.
Once the leukemic cells in the bone marrow are destroyed, which may take more than one series of treatments, it takes at least two weeks before significant numbers of healthy cells start to repopulate the marrow and enter the bloodstream. This period of very low blood cell count can be extremely dangerous. If necessary, you will be placed in a special care area of the hospital, and precautions will be taken to prevent any infection. You may also require further transfusions of red blood cells and platelets.
When the danger period is over, your condition should improve dramatically. If the treatment is successful, at some time from three weeks to three months after the beginning of treatment all signs of leukemia disappear. The bone marrow then produces normal cells, and the disease is said to have gone into remission. This means that the symptoms of the disease have disappeared or diminished, but only temporarily. The drug treatment produces a complete remission in 50 to 80 per cent of patients. You may need further drug treatment at four to six week intervals to try to prevent the disease from returning. Eventually, however, leukemia does return. Further intensive treatment may produce several more remissions, but the chances for a remission and the duration of each remission decrease with each repeated treatment. There is growing evidence that bone marrow transplantation that is carried out at the time of the first remission, both improves the long-term survival rate and produces some cures.