Synonyms

Acute myeloid leukemia; AML

Definition

Acute myelogenous leukemia (AML) is a form of cancer of the white blood cells (leukocytes). It is a relatively rare cancer that occurs more commonly in adults than in children, with more men affected than women. The median age at diagnosis is 63 years.

Current Knowledge

Symptoms

Acute forms of leukemia are characterized by the rapid proliferation of immature blood cells which rapidly crowd out mature, functional cells. In AML, the cell type is granuloid, whose cancerous change disrupts its normal ability to form red cells, some types of white cells, and platelets. Resulting symptoms are anemia, easy bruising and bleeding, and disruption to the body’s ability to resist infection. Impaired cognition and fatigue are also strongly associated with AML. Whereas impairments in these areas have been attributed to effects of chemotherapy, recent research by Meyers, Albitar, and Estey (2005) has identified differing cytokine levels present prior to chemotherapy as also contributing to these symptoms.

Pathophysiology

The malignant cell in AML is the myeloblast, a mutated and immature cell in the granulocytic series, which undergoes combinations with other mutations, to produce a leukemic clone of cells. Because the process contributes to much diversity and heterogeneity in cell differentiation, the diagnosis of AML can be challenging. It remains important, however, since the chromosomal structure of the leukemic cells is the disease’s most critical prognostic factor.

Treatment

Treatment in AML consists primarily of chemotherapy, with the goal of achieving remission. Without postremission (consolidation) therapy, almost all patients eventually relapse. Neurocognitive and neuropsychiatric symptoms are highly prevalent in patients with cancer and cause significant impairments in their ability to function. Whereas such impairments are known to be associated with aggressive cancer treatment, they are additionally attributed to biologic mechanisms underlying the cancer itself. Recent research (Meyers et al. 2005) on AML has made linkages between cytokine-immunologic activation and factors including cognitive functioning, significant fatigue, and quality of life in AML patients studied prior to the initiation of treatment.

Cross-References