Bay Biosciences provides high-quality biopsy tissue samples, formalin fixed paraffin embedded (FFPE) tissue blocks, with matched fresh frozen sera (serum), plasma, and peripheral blood mononuclear cells (PBMC) bio-fluids, from patients diagnosed with acute myeloid leukemia (AML).
The sera (serum), plasma and peripheral blood mononuclear cells (PBMC) biofluid specimens are processed from patients peripheral whole-blood using customized collection and processing protocols from acute myeloid leukemia (AML).
Fresh frozen tissue and matched biofluid samples were, collected from unique patients diagnosed with acute myeloid leukemia (AML).
Bio-samples are provided to a valued pharmaceutical customer for research, diagnostics, discovery, and drug development.
Acute myeloid leukemia (AML) Overview
Acute myeloid leukemia (AML) is a common leukemia in adults, rarely, children get this cancer. AML starts in bone marrow and quickly spreads to the lymph nodes, organs, spine and brain.
Chemotherapy is the main treatment for . Some patients get stem cell transplants. AML often comes back, and the disease may require lifelong treatment. However, treatments are available, and they may send the cancer into remission.
According to the National Cancer Institute this year 20,050 patients will receive a new diagnosis of AML in the United States. NCI also predicts that 11,540 people will die from the disease.
AML can develop at any age, but it is uncommon in patients younger than 45 years. The average age at diagnosis is 68 years.
There are different types of AML, and some are more aggressive than others.
Cancer develops when certain cells in the body reproduce without the usual controlling factors.
AML involves the body producing too many nonfunctioning, immature white blood cells. These are called blasts. They crowd out the useful cells, leading to a range of symptoms and complications.
Acute myeloid leukemia develops suddenly, while chronic leukemia lasts for a long time and progresses gradually. In a person with acute leukemia, the blasts crowd out healthy cells more quickly than in a patient with chronic leukemia.
In a healthy individual, blasts make up to 5% or less of bone marrow and there are no blasts in the blood. Usually, for a doctor to diagnose AML, the person’s blood or marrow needs to contain at least 20% blasts.
Signs and symptoms generally develop gradually and become more severe as the blast cells take up more space in the blood.
Signs and Symptoms of Acute myeloid leukemia (AML)
Acute myeloid leukemia (AML) can cause many different signs and symptoms. Some are more common with certain subtypes of AML. The general symptoms of AML can be similar to those of the flu.
Other symptoms, such as bruising and bleeding, result from complications that stem from changes in blood cell counts.
AML signs and symptoms can include the following:
- A fever
- Abdominal pain, due to swelling in the liver (hepatomegaly), spleen, or both
- Breathlessness or shortness of breath
- Confusion
- Fatigue
- Frequent infections
- Loss of appetite
- Pain in the joints and the bones
- Pallor
- Skin that bruises easily
- Swollen lymph nodes (glands)
- Small red spots under the skin due to bleeding
- Slurred speech
- Unexplained Weight Loss
- Unusual sweating
- Unexplained regular bleeding, perhaps of the nose or gums
As AML spreads to other organs, a wide range of symptoms can develop. If the blast cells enter the central nervous system, for example, the patient may experience headaches, blurred vision, dizziness, seizures, and vomiting.
AML is a fast-growing cancer. Anyone who notices unusual symptoms should see a doctor immediately, without delay. The sooner a patient starts treatment, the better the likelihood that it will be effective.
Causes of Acute myeloid leukemia (AML)
Doctors do not know what causes healthy bone marrow cells to become leukemia cells. However, there is evidence that exposure to certain environmental toxins can increase the risk.
Acute myeloid leukemia (AML) occurs when a bone marrow cell develops changes (mutations) in its genetic material or DNA. A cell’s DNA contains the instructions that tell a cell what to do. Normally, the DNA tells the cell to grow at a set rate and to die at a set time. In acute myelogenous leukemia, the mutations tell the bone marrow cell to continue growing and dividing.
When this happens, blood cell production becomes out of control. The bone marrow produces immature cells that develop into leukemic white blood cells called myeloblasts. These abnormal cells are unable to function properly, and they can build up and crowd out healthy cells.
It’s not clear what causes the DNA mutations that lead to leukemia, but doctors have identified factors that increase the risk.
Stages of Acute myeloid leukemia (AML)
There are two main systems that have been used to classify AML into subtypes. They are the French-American-British (FAB) classification and the newer World Health Organization (WHO) classification.
French-American-British (FAB) Classification
The FAB classification was created in the 1970s by a group of French, American, and British leukemia experts who divided AML into subtypes, M0 through M7, based on the type of cell the leukemia develops from and how mature the cells are. This was based largely on how the leukemia cells looked under the microscope after routine staining.
- M0: Undifferentiated acute myeloblastic leukemia
- M1: Acute myeloblastic leukemia with minimal maturation
- M2: Acute myeloblastic leukemia with maturation
- M3: Acute promyelocytic leukemia (APL)
- M4: Acute myelomonocytic leukemia
- M4 eos: Acute myelomonocytic leukemia with eosinophilia
- M5: Acute monocytic leukemia
- M6: Acute erythroid leukemia
- M7: Acute megakaryoblastic leukemia
Subtypes M0 through M5 all start in immature forms of white blood cells. M6 AML starts in very immature forms of red blood cells, while M7 AML starts in immature forms of cells that make platelets.
World Health Organization (WHO) Classification
Unlike the FAB classification system, the WHO classification system takes into account many of the factors that are now known to affect the prognosis (outlook) that can better classify AML.
The WHO system divides AML into several groups, including:
- AML with certain genetic abnormalities (gene or chromosome changes)
- Disease with myelodysplasia-related changes
- AML related to previous chemotherapy or radiation
- Disease not otherwise specified (this includes cases of AML that don’t fall into one of the above groups)
- Myeloid sarcoma (also known as granulocytic sarcoma or chloroma)
- Disease proliferations related to Down syndrome
- Undifferentiated and biphenotypic acute leukemias (leukemias that have both lymphocytic and myeloid features), which are sometimes called mixed phenotype acute leukemias (MPALs)
Risk Factors of Acute myeloid leukemia (AML)
Doctors don’t exactly know why someone gets AML. But some things may make you more likely to get it. Acute myeloid leukemia (AML) risk factors include the following:
Smoking: People who smoke appear to have a higher risk of AML. This may be because benzene is present in cigarette smoke. Smoking can affect the body in many ways.
Benzene: Coming into contact with certain chemicals such as benzene (a solvent that’s used in oil refineries and other industries and that’s found in cigarette smoke), pesticides, ionizing radiation, some cleaning products, detergents, and paint strippers.
Benzene is a component of crude oil and gasoline. It is also present in household glues, cleaning products, tobacco smoke, gasoline, and paint stripping products, among others.
People who work in the production of plastics, synthetic fibers, rubber lubricants, drugs, pesticides, and many other products may have an increased risk of exposure to benzene.
Overall, take care to avoid:
- Breathing in gasoline and solvent fumes
- Getting benzene-related products on the skin
- Spilling benzene-related products on the ground
Health and Genetic Factors: People with certain health conditions may have a higher risk of developing AML.
These conditions include:
- Certain blood disorders, such as myelodysplasia, myeloproliferative disorders (for example, chronic myelogenous leukemia)
- Down syndrome
- Fanconi anemia
Chemotherapy: Some chemotherapy drugs used to treat other cancers, such as cyclophosphamide, doxorubicin, melphalan, and mitoxantrone.
Radiation: Exposure to high doses of radiation.
Genetics: A parent or sibling who had AML.
There’s no way to prevent AML, but you may lower your risk by not smoking and limiting your contact with chemicals.
Diagnosis of Acute myeloid leukemia (AML)
If your doctor notices symptoms that could indicate AML, they will need the following information from the patient:
- Inquire about symptoms
- Ask about personal and family medical histories
- Perform a patients physical examination
If the presence of leukemia is suspected, they will recommend blood and bone marrow tests.
Physical Exam
At your visit, your doctor will ask questions about your health. During the exam, your doctor will check your body for signs of cancer, such as bruises or spots of blood under your skin.
Tests for AML
AML affects immature blood cells called stem cells that grow into white blood cells, red blood cells, and platelets. These blood cells are made in the bone marrow, the spongy material inside your bones. In AML, the stem cells are abnormal and can’t grow into healthy blood cells.
- Blood tests
- Bone marrow tests
- Imaging tests
- Gene tests
- Lumbar puncture
Blood Tests
During a blood test, your doctor uses a needle to take a sample of blood from a vein in your arm. Doctors use different types of blood tests to diagnose AML:
- Complete blood count (CBC). This test checks how many white blood cells, red blood cells, and platelets you have. With AML, you may have more white blood cells and fewer red blood cells and platelets than normal.
- Peripheral blood smear. In this test, a sample of your blood is examined under a microscope. It checks the number, shape, and size of white blood cells, and looks for immature white blood cells called blasts.
Bone Marrow Test
To confirm that you have AML, you’ll also need a bone marrow test. A doctor will take a very small sample of the bone marrow. Then another doctor will look at the cells under a microscope to see if abnormal (cancer) cells are present. If 20% or more of the blood cells in your bone marrow are immature, you may be diagnosed with AML.
Lumbar Puncture (Spinal Tap)
This test uses a needle to remove a small sample of cerebrospinal fluid (CSF), the fluid that surrounds your brain and spinal cord. The CSF is examined under a microscope to see if it contains leukemia cells.
Imaging Tests
Imaging tests use radiation, sound waves, and magnets to make pictures inside your body. AML doesn’t form tumors that show up on scans, but your doctor might use these tests to look for an infection or another problem AML can cause.
These imaging tests can help your doctor diagnose AML:
CT, or computed tomography. This powerful X-ray makes detailed pictures inside your body. A CT scan can show whether AML has enlarged your spleen or lymph nodes. You might get a special dye by mouth or into a vein before the test. This dye helps your doctor see your organs more clearly on the scan.
Ultrasound. It uses sound waves to see whether your lymph nodes, liver, spleen, and kidneys are enlarged.
Gene Tests
There are several forms of AML. Your doctor can find out which one you have by looking for gene changes in a sample of your blood or bone marrow. This can help your doctor find the treatment that is most likely to work on your cancer.
These tests include the following:
Cytogenetic analysis looks for chromosome changes in your cells. Chromosomes are stretches of DNA. Sometimes in AML, two chromosomes switch DNA. This is called a translocation.
Immunophenotyping tests look for substances called markers on the surface of leukemia cells. Different types of AML cells have their own unique markers.
Fluorescent in situ hybridization (FISH) looks for abnormal chromosomes in your cells using special dyes that attach to certain parts of the chromosome.
Polymerase chain reaction (PCR) uses chemicals to find changes in genes.
Treatment of Acute myeloid leukemia (AML)
Treatment options for AML include the following:
- Chemotherapy
- Radiation therapy
- Stem cell therapy, also known as bone marrow transplantation
- Targeted therapy
Treatment aims to reduce the blast count in bone marrow to below 5%.
Chemotherapy is the main treatment. It involves using powerful drugs to kill cancer cells throughout the body. However, it can cause severe adverse effects.
Stem cell therapy, or bone marrow transplantation, can help the body recover after high doses of chemotherapy. The doctor may recommend this to help a person tolerate a higher dosage of chemotherapy.
Targeted therapy involves drugs that target specific substances often proteins, that play a role in promoting cancer growth. Blocking these proteins can help prevent or delay the growth. A doctor may recommend this treatment instead of chemotherapy or alongside it.
Radiation therapy might help some AML patients. It can help reduce bone pain, for example, if chemotherapy has not been effective.
When blast levels have fallen below 5% the cancer is in remission. In around two-thirds of people who have induction chemotherapy for AML, it will go into remission. “Induction chemotherapy” is the term for chemotherapy that aims to induce remission.
Whether treatment will lead to remission depends on various factors, including the type of AML and the person’s age and overall health.
AML will go into long-term, and possibly lifelong, remission in up to 50% of patients who have the disease.
Prognosis for Adults with Acute myeloid leukemia (AML)
Approximately 2 out of 3 adults with AML go into remission after getting chemotherapy. Remission means the patient doesn’t have disease symptoms anymore. There are no detectable cancer cells in the bone marrow and the normal healthy cells are growing again.
Because AML often comes back, you may continue to get chemotherapy to destroy any remaining cancer cells and keep them away. Your healthcare provider may call this step post-remission (consolidation) chemotherapy. Up to half of people who get this treatment go into long-term remission. AML accounts for fewer than 2% of all cancer-related deaths.
If cancer comes back within 12 months of treatment, your provider may recommend a stem cell transplant if you are healthy enough to tolerate it. If you’ve relapsed, a bone marrow transplant is often the only chance for cure once the leukemia has gone back into remission.
Prognosis for Children with Acute myeloid leukemia (AML)
Children respond better to AML treatments than adults. Almost all kids (up to 90%), go into remission after initial chemotherapy treatment. But they still need more chemotherapy (post-remission/consolidation therapy) to destroy any lingering cancer cells.
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